DEFINITIONS OF QUALITY IN HEALTHCARE
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| DEFINITIONS OF QUALITY IN HEALTHCARE |
"Quality"
Noun: "peculiar and essential character"; "an inherent or distinguishing characteristic"; "superiority of kind"; "degree or grade of excellence"
Adjective: "having a high degree of excellence"
Quality means doing the right things right the first time. Standards are created when experts are able to understand what the right things are and how the right things are best achieved. So, quality can be said to be, at least in part, compliance with standards. However, when recipients define quality, they judge whether or not the right things are done in ways that meet their own needs and expectations.
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The Centers for Medicare and Medicaid Services (CMS)
defines healthcare quality as "the right care for every person every time."
According to Avedis Donabedian
an international leader in healthcare quality until his death in 2000, how we define quality in healthcare depends on:
1) Whether only practitioner assessment or also patient and health system contributions are included;
2) How broadly "health" and responsibility for health are defined;
3) Whether maximally or optimally effective care is sought; and
4) Whether the optimum is defined according to individual or social preferences.
The Juran Institute defines quality as both:
1- "Freedom from deficiencies":
A deficiency is any avoidable intervention required to achieve an equivalent patient outcome;
Examples:
1. Healthcare-associated (nosocomial) infection, postoperative site infection.
2. Emergency Department (ED) triage delay.
3. Unscheduled return to ED/urgent care, surgery (inpatient or outpatient).
4. Managed care treatment authorization delay.
5. Excessive wait time (physician office, ancillary service, ED, nursing care).
6. Lost lab results, X-Rays, medications, patient belongings.
7. Cold meals (acute care, long-term care, adult day care, residential care, home care).
8. Premature discharge or release from treatment (acute care, skilled or subacute care, long term care, partial hospitalization, ambulatory surgery, home care).
2- "Product features":
Both services and goods that attract and satisfy patients, meet customer expectations, and distinguish one practitioner or organization from others.
Examples:
1. Case management/care coordination.
2. Pleasant waiting area (with current magazines).
3. Knowing what to expect.
4. Knowing all treatment options.
5. Computerized health record.
6. Food access in room, as appropriate (acute care, long term care, home care).
7. Follow-up care (telephone queries, clear instructions, home care, return visits).
IOM: Quality of Care:
The Institute of Medicine collected and analyzed over 100 definitions of quality of care and came to this consensus definition:
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.
This quality of care definition is the same one used by The Joint Commission in the U.S. and the Joint Commission International (in their Glossaries).
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AHRQ: Quality Healthcare:
The U.S. government Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research (AHCPR), defines quality healthcare as healthcare that is "...accessible, effective, safe, accountable, and fair...." This means:
- Providers deliver the right care to the right patient at the right time in the right way.
- Patients can access timely care, have accurate and understandable information about risks and benefits, are protected from unsafe health care services and products and have reliable and understandable information on the care they receive.
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