The Quality of Health Care

PRESENTED BY: MR. JALLOW

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 Quality of Health Care
• Quality is defined at the degree to which
health services for individuals and patient
populations increase the likelihood of
desirable health outcomes and are
consistent with current professional
knowledge.

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 How to Measure Quality
• Institutional settings
• Individual providers
• Direct provision of clinical services
• Patient satisfaction
• Prospectively or retrospectively

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 Three Dimensions of
Measurement for Quality Assessment
1. Structure
– Reflects environment in which care is provided.
2. Process
– Reflects what is actually done to the patient.
3. Outcome
– Reflects the end result of the care provided.

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 Factors
Contributing to the Quality Movement
• Increase in the quality of health care data

– Discovery of improved treatment practices.

• An increase in the public’s demand for
greater provider accountability and positive
patient outcomes.

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 Factors
Contributing to the Quality Movement
• Advances in information technology.
• Increase in health care costs and its
impact on employers.
• Sizable gaps in quality across various
areas of patient care.

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 The Quality Gap
• Difference between health care processes
or outcomes observed in practice and
those thought to be achievable with the
most current and effective professional
knowledge.

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 The Quality Gap
• May be a direct result of the following:
– A gap in the dissemination of clinical
knowledge.
– The cost-effectiveness of the practice.
– Differences in the application of practice
between clinical research settings and
individual provider settings.

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 Strategies to
Improve the Quality Gap
• Education
• Feedback
• Physician involvement
• Administrative rules
• Financial incentives
• Financial penalties

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 Taxonomy of
Quality Improvement Strategies
Strategy Examples

Provider reminder systems Reminders in medical charts,

computer-based decision
support

Facilitated relay of clinical Electronic transmission of

data to providers clinical data

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 Taxonomy of
Quality Improvement Strategies
Audit and feedback Feedback on performance,
quality indicators and
reports, benchmarking
Provider education Workshops, conferences,
educational outreach visits

Patient education Classes, pamphlets

Promotion of self- Materials and devices

management promoting self-management

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 Taxonomy of
Quality Improvement Strategies
Patient reminder systems Postcards, phone calls

Organizational change Case management, disease

management, TQM and CQI
techniques

Financial incentives, Financial incentives based

regulation, and policy on achievement

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 Health Care Disparities
• “The condition or fact of being unequal, as
in age, rank, or degree.”
• May exist at the individual level due to
differences in underlying rates of disease,
lifestyle choices, or differences in the care-
seeking behavior of patients.

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Types of Health Care Disparities
• Racial
• Ethnic
• Socioeconomic
• Geographic

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 Examples
• Minorities are more likely to be diagnosed
with late-stage breast cancer and colorectal
cancer when compared to whites.
• Minorities and persons of lower
socioeconomic status are more likely to die
from HIV.

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 Health Care
Disparities and Access
• Access to health care is a prerequisite to
obtaining quality care.
• Access to appropriate services may be
limited as the availability of care may
depend on a patient’s ability to pay,
management, delivery of health care
services, and provider beliefs.

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 Health Care
Disparities and Access
• Lack of access to health care services may
result in the following:
– Adverse health outcomes
– Presentation of illness at a less treatable stage
– Avoidable hospital admissions
– An increase in mortality rates

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 Health Care
Disparities and Access
• Increasing access to health care services
is a key factor in reducing or eliminating
these disparities.
• Systematic collection and analysis of
health care data will be a vital step towards
eradicating health care inequalities.

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 Other Quality
Improvement Strategies
• Report cards
• Standardization of care

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 Report Cards
• Reports cards are quality-related feedback
mechanisms utilized for health plans,
provider organizations, and individual
professionals.

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 Report Card Evaluations
• Access to needed services
• Qualifications of the providers
• Planned promotions of appropriate
preventive services
• Tests
• Screenings
• Health plan evaluation of new medical
procedures and drugs
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 Standardization of Care
• Benchmarking
• Quality assessments
• Evidence-based practice guidelines
• Clinical pathways
• Increased emphasis on outcome measures

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 Improvement
Strategies for the Future
• Increase the focus on basic and cost-
effective preventive care.
• Increase the availability of quality health
care data.
• Identify the geographic locations in need of
health care services and identify successful
programs for addressing those needs.

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• THE END
• PREPARE FOR EXAMS NEXT WEEK

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