The Anatomy of Quality Flashcards
Is there an agreed on definition for quality?
No
It is a subjective thing (different for everyone)
What is the definition of quality according to the institute of medicine?
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 professional knowledge
What are the key terms in the IOM definition?
Health services - a wide array of services that affect health (physical and mental)
Increases the likelihood - quality is not identical to good outcomes and recognizes that there is always an unknown aspect of healthcare
Individuals and populations - draws attention to the different perspectives that need to be addressed
Desired health outcomes - take the patient’s preferences and values into account
Current professional knowledge - health professionals must stay up-to-date on the rapidly expanding and changing knowledge
What are the aspects of the donabedian model of measures of quality?
Structure - the capacity of health systems to deliver care (number of staff, equipment, and facilities)
Process - interactions between patients and clinicians (the doing, best practice standards)
Outcomes - changes in the patients health status as the result of health care interventions
*this is the way that we understand and discuss quality today
What are the major approaches to measuring quality in healthcare settings?
Assessing the appropriateness of care
Assessing adherence to professional standards
What is appropriateness of care?
The process is considered appropriate if the expected health benefits exceed the risks
What is adherence to professional standards?
A list of quality indicators based on standards of care developed through evidence based practice, professional medical associations, etc.
What are the 4 types of problems in quality of healthcare?
Underuse (to little care, needed services that were not provided)
Overuse (too much case, overuse of antibiotics, unnecessary surgery, excessive imaging, etc.)
Variation in use (variations in practice, length of stay, invasiveness of procedures, etc.)
Misuse (mistakes in care, wrong medications, misdiagnosis, failure to follow-up)
What are the models of oversight?
Peer review (certification of specialty based professional training, clinical practices, and/or organizations)
Accreditation (independent org that uses published criteria to assess quality and accredit provider sittings)
Inspection (national or regional statutes prescribing levels of competence and/or safety)
Who oversees quality?
The oversight of healthcare quality in the United States is accomplished both through professionally based, private sector accrediting bodies and through federal and state regulatory agencies
Who are the primary regulators of quality?
Federal Agencies (Agency for Healthcare Research and Quality, Center for Medicare and Medicaid Services)
State governmental agencies (Medicaid)
Professional Associations (NATA, APTA, National Committee on Quality Assurance)
Independent Accrediting Agencies (JACHO, NCQA)
Does medicare have ongoing quality initiatives?
Yes
When did the concern over quality start?
1990s
As we developed increased concern over the allocation of resources in healthcare, concerns about quality emerged
What do organizations that are concerned with the oversight of quality generally require?
Documented proof of quality of care
This takes the form of proof of adherence to guidelines as well as performance and outcome data
