Assessing Quality Healthcare

By Abdulla Israr & Simran Rani

ASSESSING QUALITY HEALTHCARE

Introduction

·       Quality in health care refers to the extent to which health services provided to individuals and populations improve desired health outcomes.

·       Assessing attributes includes

o   Safety

o   Effectiveness

o   Patient-centeredness

o   Timeliness

o   Efficiency

o   Equity

o   Accessibility

Attributes of a Good Patient–Practitioner Relationship

  • Trust: The patient must feel confident in the practitioner’s competence and integrity.
  • Respect and Empathy: Practitioners should show understanding and concern for patients’ conditions and emotions.
  • Effective Communication: Clear explanation of diagnosis, treatment options, and follow-up instructions.
  • Shared Decision-Making: Engaging patients in decisions about their care.
  • Confidentiality: Maintaining privacy of patient information.
  • Continuity of Care: Building long-term relationships that improve outcomes over time.

Measurement of Quality

  • Structure Measures: Assess the setting of care (e.g., facilities, equipment, staff qualifications).
  • Process Measures: Evaluate how care is delivered (e.g., adherence to guidelines, communication).
  • Outcome Measures: Focus on the results of care (e.g., patient health status, satisfaction, recovery rates).
  • Patient Feedback: Surveys and interviews assessing patient satisfaction and experiences.
  • Clinical Indicators: Infection rates, mortality rates, readmission rates, etc.

Procedure for Formulating Explicit Criteria and Standards

  1. Identify the Area of Care: Choose specific conditions or services for which standards are to be developed.
  2. Review Evidence and Guidelines: Collect clinical evidence, research studies, and best practices.
  3. Formulate Criteria:
    • Structure Criteria: Requirements for resources and infrastructure.
    • Process Criteria: Best practices in clinical care.
    • Outcome Criteria: Expected results and indicators of success.
  4. Set Performance Standards: Define acceptable levels of performance.
  5. Validation and Expert Review: Involve healthcare professionals for consensus and refinement.
  6. Implement and Monitor: Use standards for auditing and quality improvement.
  7. Review and Update: Periodically revise based on new evidence and practices.

Determinants of Quality

  • Human Resources: Skills, training, attitudes, and number of healthcare providers.
  • Infrastructure: Facilities, equipment, technology, cleanliness, and accessibility.
  • Policies and Protocols: Guidelines, regulations, and adherence to standards.
  • Management and Leadership: Organizational culture, leadership style, and administration.
  • Patient Factors: Demographics, health literacy, socioeconomic status, and preferences.
  • Financial Resources: Funding for healthcare services, affordability, and insurance coverage.

Donabedian Model: Structure – Process – Outcome

Avedis Donabedian proposed a widely used model to assess healthcare quality:

a) Structure

  • Refers to the environment in which healthcare is provided.
  • Includes:
    • Physical facilities and equipment
    • Staff qualifications and training
    • Organizational characteristics
  • Example: Number of ICU beds, availability of MRI machines.

b) Process

  • Refers to how healthcare is provided.
  • Includes:
    • Diagnosis and treatment procedures
    • Communication and education
    • Adherence to clinical guidelines
  • Example: Percentage of diabetic patients receiving annual eye exams.

c) Outcome

  • Refers to the results of healthcare.
  • Includes:
    • Recovery rates
    • Mortality and morbidity statistics
    • Patient satisfaction
  • Example: Reduction in hospital-acquired infections.

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