Quality / Access Flashcards
Iron Triangle
Access (top)
Quality, Cost / Spending (bottom)
Iron refers to the tradeoff between the 3
Implications of Access to HC
- key determinant of health
- benchmark
- reflects equity
- linked to quality
Access evaluation metrics
- specialty / geographic maldistribution
- wait times
- un-insurance rate (ACA reduced by ~1/3, from 30 m to 10m)
Unmet care need due to cost
~60% of US residents do not receive care / have a misdiagnosis due to COST
Quality (IOM)
Degree to which health services increase the likelihood of a desired outcome AND are consistent w current professional knowledge
Macro view of quality
looks at quality from a population standpoint
Indicators of macro quality
life expectancy
incidence / prevalence of disease
lifestyle / health behavior
Micro view of quality
focus on point of care
clinical / interpersonal aspects of delivery
quality of life
quality of life
environmental comfort
self-governance
human factor
interpersonal aspect of care
how do clinicians interact with patients
clinical aspects of care delivery
- technical quality (skill / appropriateness)
2. undertreatment / overtreatment / mistreatment
4 types of medical errors
- medication / prescription
- surgical
- diagnostic
- systematic factors
QALY
quality adjusted life year
used to standardize health status / asses costs
scale of 0 to 1
CUA
cost utility analysis
cost in $ / benefits in unit
form of cost-effectiveness to compare treatments
2 Process Improvement Initiatives
- clinical practice guidelines
2. critical pathways
Clinical practice guidelines
Science based descriptions on clinical processes, manage clinical issues with EBM
Critical pathways
Outcome / patient based management, better care coordination.
How to improve care quality
- Management tools
- Health IT
- Transparency
- Change reimbursement
- Teaching
Underinsurance
insurance coverage inadequate to cover major illness
OOP spend > 10% of income or OOP spend > 5% if you are below 200% FPL
