Medicare A Strategy for Quality Assurance, Volume II: Sources and Methods (1990) / Chapter Skim
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5. Defining Quality of Care
5. Defining Quality of Care
Pages 116-139
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From page 116... ...
This chapter documents that analysis and presents the committee's final definition, which became a focal point for the committee's report. METHODS During the study a large number of definitions of quality of care and sets of parameters that should be considered in defining quality were assembled.
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From page 117... ...
Second, we combined two aspects of accessibility to care. Finally, four preliminary dimensions (reference to a particular setting such as inpatient or home health care; generic reference to outcome; generic reference to process and outcome; and ge TABLE 5.1 Quality Dimensions and Frequency of Occurrence in 100 Definitions of Quality Dimensionsa Frequency of Occurrence Scale of quality Nature of entity being evaluated Type of recipient identified Goal-oriented Risk versus benefit tradeoffs Aspects of outcomes specified Role and responsibility of recipient asserted Constrained by technology and state of scientific knowledge Technical competency of providers Interpersonal skills of practitioners Accessibility Acceptability Constrained by resources Standards of care Constrained by consumer and patient circumstances Documentation required Continuity, management, coordination Statements about use 22 21 24 15 10 12 16 16 34 30 30 27 21 13 13 6 3 The first 8 dimensions were explicitly incorporated in the committee's definition.
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From page 118... ...
KEY DIMENSIONS USED BY SEVERAL GROUPS IN DEFINING QUALITY The first 8 dimensions discussed in this section are those ultimately included in the committee's definition. They are discussed in the order in which they appear in that definition.
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From page 119... ...
Individual-specific terms used in quality definitions are patient, customer, consumer, elderly individual, and Medicare beneficiary or enrollee. Population-specific terms treat these individuals as groups or subgroups but could also be expanded to include terms such as society, societal well-being, and public health.
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From page 120... ...
Nonmedical goals such as patient satisfaction and consistency with patient preferences are considered by many to be of great importance and a critical dimension of quality care for the elderly. Several definitions consulted in this analysis are fairly specific regarding the goal dimension, which in essence describes an action with a specific aim such as "helping a patient to maintain independent living." Among them: " .
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From page 121... ...
"The degree to which patient care services increase Me probability of desired patient outcomes and reduce the probability of undesired patient outcomes, .
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From page 122... ...
Generic terms include the following: anticipated outcome,2 independent existence,4 desired patient outcomes,7 36 improved health,~° inclusive measure of patient welfare, level of well-being,30 and clinical outcomes.3844 Examples of terms for somewhat more specific outcomes are as follows: least morbidity and mortality in the population,5 highest level of functioning,~8 social and psychological well-being,34 and outcomes that are optimal in arresting disease or restoring function.24 42 Finally, one of the more detailed phrases about outcomes refers to the physiological status, physical function, emotional and intellectual performance, and comfort.2i Role and Responsibility of Recipient Asserted This dimension, if present in a definition' implies that the recipient is more than a passive party. The types of responsibilities differ depending on whether the recipient is an individual or a population.
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From page 123... ...
. care that is based on the application of the sound judgment of the appropriate professionals involved, applied to the specific individual concerns and needs of the patient; and .
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The acceptability dimension in quality definitions is applicable usually to outcomes of the health encounter, al
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From page 125... ...
This standard may conflict with professional standards of care, which are rarely defined in terms of economics; professional standards of care honor the principles of beneficence and autonomy more so than the principle of distributive justice. When quality is defined with a resource constraint dimension, at what point on an ordinal or a nominal scale of quality is inadequate care due to resource constraints not acceptable?
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From page 126... ...
The standards are generally based on the judgment or the practice of health care professionals. Examples supporting this dimension as a component of defining quality are as follows: "Quality patient care is that practice in any given situation which is thought by knowledgeable clinicians to be in consonance with those practices of the pertinent professional community .
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From page 127... ...
program and aggressive internal quality assurance efforts tend to increase the overall amount of information documented in patients' records. This emphasis on documentation may or may not directly affect the quality of care, but accurate and thorough documentation is needed to assess care along other key dimensions such as technical competence, constraints of patient circumstances, and continuity.
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From page 128... ...
and patients without either over- or under utilization of resources."'9 "Quality healthcare is the provision of exactly the right measure of service to restore the patient to tile level of well-being he/she is capable of achieving."30 THE COMMITTEE'S DEFINITION As defined by the IOM study committee, quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current
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From page 129... ...
. In turn, that benefit is expected to reflect considerations of patient satisfaction and well-being, broad health status or qualityof-life measures, and the processes of patient-provider interaction and decision making.
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From page 130... ...
In many examples herein, the author has excerpted the phrases from material submitted to the study. An attempt has been made to retain the actual words used for defining quality but to eliminate extraneous words from the submitted texts.
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7. The degree to which patient care services increase the probability of desired patient outcomes and reduce the probability of undesired outcomes, given the current state of knowledge.
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Considerations in Defining Quality in Health Care. Paper prepared for the Institute of Medicine Study to Design a Strategy for Quality Review and Assurance in Medicare, 1988.
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16. Quality of care is that kind of care which is expected to maximize an inclusive measure of patient welfare after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts.
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From page 134... ...
is care provided in the appropriate setting, which results in patient outcomes that are optimal in arresting disease or restoring function within the current limitations of medical science. American Health Care Institute.
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28. Quality patient care is that practice in any given situation which is thought by knowledgeable clinicians to be in consonance with those practices of the pertinent professional community (a standard defined by the pertinent professional community)
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From page 136... ...
35. High quality care is first, care that is desired by an informed patient; second, care that is based on the application of the sound judgment of the appropriate professionals involved, applied to the specific individual concerns and needs of the patient; and third, care that is agreed upon and carried out in a relationship of mutual trust and respect.
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From page 137... ...
seek to achieve the informed cooperation and participation of the patient in the care process and in decisions concerning that process; 5) be based on accepted principles of medical science and the proficient use of appropriate technological and professional resources; 6)
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From page 138... ...
44. Parameters: Quality is a function of clinical outcome plus appropriate process plus patient satisfaction plus credentialing plus utilization management plus service plus risk management plus .
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From page 139... ...
52. Achieving quality means the continuous improvement of services to meet the needs and expectations of the patients, the physicians, the payers, the employees, and the communities we serve.
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