Health care quality

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Quality of health care is the level of value provided by any health care resource, as determined by some measurements. As with quality in other areas, this is an assessment of whether something is good enough and is appropriate for its purpose. The goal of health care is to provide high-quality medical resources to all who need it; that is, to ensure a good quality of life, cure the disease whenever possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to try to determine the quality of health care, including the number of reductions or reductions of illnesses identified by medical diagnoses, reduction in the number of risk factors that people have followed preventive care, or health surveys. indicators in the population that access certain types of treatments.

Video Health care quality

Definisi

The quality of health care is the extent to which health care services for individuals and populations increase the likelihood of desired health outcomes. Quality of care plays an important role in describing the iron triangle of health care, which determines the complex relationship between quality, cost, and accessibility of health care within a community. Researchers measure the quality of health care to identify problems caused by overuse, underutilization, or abuse of health resources. In 1999, the Institute of Medicine released six domains to measure and explain the quality of care in health:

Safe - avoid injury to patients from treatments intended to help them.
Effective - avoid overuse and misuse of care.
Patient-Centered - provides a unique treatment for the patient's needs.
Timely - Reduced waiting times and delays that are harmful to patients and providers.
Efficient - avoids waste of equipment, supplies, ideas, and energy.
Equality - provides care that does not vary across intrinsic personal characteristics.

While it is important to determine the effect of health care research interventions, measuring quality of care poses several challenges due to the limited number of measurable outcomes. Structural measures describe the provider's ability to provide high-quality care, the process steps describe the actions taken to maintain or improve public health, and the outcome measures illustrate the impact of health care interventions. Furthermore, because strict regulations are placed on healthcare research, data sources are not always complete.

Assessment of the quality of health care can occur at two different levels: ie in each patient and population. At the individual patient level, or micro level, the assessment focuses on the service at the point of delivery and subsequent effects. At the population, or macro-level level, health care quality assessments include indicators such as life expectancy, infant mortality, incidence, and prevalence of certain health conditions.

A quality assessment measures this indicator against a defined standard. The steps can be difficult to determine in health care. Quality assurance differs from quality assessment and is based on total quality management principles (TQM). This is a method of using system-wide quality assessment steps to provide improved, high-quality care.

Maps Health care quality

Methods to rate and improve

The Donabedian model is a common framework for assessing the quality of health care and identifies three domains in which the quality of health care can be assessed: structure, processes, and outcomes. The three domains are closely intertwined and build each other. Improvements in structure and process are often observed in the results. Some examples of improvements in the process are: clinical practice guidance, cost efficiency analysis, and risk management, which consists of proactive steps to prevent medical errors.

Cost Efficiency Cost Efficiency, or cost-effectiveness, determines whether service benefits outweigh the costs incurred for providing services. Health care services are sometimes not cost-effective because of too much use or lack of use. Overutilization, or overuse, occurs when the value of health care is diluted with wasted resources. As a result, reducing others from the potential benefits of getting the service. The cost or risk of treatment is greater than the benefits of excessive health care. In contrast, underutilization, or underuse, occurs when the benefits of treatment outweigh the risks or costs, but are not used. There is potential for adverse health outcomes with a lack of use. One example is the lack of detection and treatment of early cancer that leads to a decrease in cancer survival rates.

Critical Pathways Critical Pathways is a results-based and patient-centered case management tool that takes an interdisciplinary approach by "facilitating the coordination of care among multiple clinical departments and carers". Health care managers use critical paths as a method to reduce variation in care, reduce resource use, and improve the quality of care. Use critical paths to reduce costs and improve quality errors by providing a systematic approach to assessing health care outcomes. Reducing variations in practice patterns promotes increased interdisciplinary cooperation among health care systems.

Professional health perspective

The quality of health care provided by health professionals can be assessed from the results, technical performance of care and interpersonal relationships.

The "outcome" is a change in the patient's health, such as reduced pain, relapse, or mortality. Major differences in outcomes can be measured for each of the medical service providers, and smaller differences can be measured by studying large groups, such as doctors with low and high volumes. Significant initiatives to improve health quality outcomes have been conducted that include clinical practice guidelines, cost efficiency, critical pathways, and risk management.

Clinical Practice Guidelines "Technical performance" is the extent to which health professionals conform to best practices set by medical guidelines. Clinical practice guidelines, or medical practice guidelines, are scientific-based protocols to assist providers in adopting a "best practice" approach in providing care for certain health conditions. Standardized medical practices improve the quality of care by simultaneously promoting lower costs and better outcomes. The presumption is that providers follow medical guidelines to provide the best care and give hope of good results. Technical performance is judged from a quality perspective regardless of actual results - so for example, if a doctor provides care according to guidance but the patient's health does not improve, then by this measure, the quality of "technical performance" is still high. For example, Cochrane's review found that computer-generated reminders improved doctors' compliance with guidelines and standards of care; but has no evidence to determine whether or not this really has an impact on patient centered health outcomes.

Risk Management Risk management consists of "proactive efforts to prevent side effects associated with clinical care" and is focused on avoiding medical malpractice. Health care professionals are not immune to lawsuits; Therefore, health care organizations have taken the initiative to establish specific protocols to reduce malpractice litigation. Malpractice worries may result in defensive treatment, or the threat of malpractice litigation, which may jeopardize the safety and care of patients by encouraging additional tests or treatments. One of the most widely used forms of defensive treatment is ordering expensive imagery that can be wasted. However, other defensive behaviors may actually reduce access to care and pose a risk of physical harm. Many specialist doctors report doing more for patients, such as using unnecessary diagnostic tests, because of the risk of malpractice. In turn, it is imperative that the risk management approach uses cost efficiency principles with standard practice guidelines and critical paths.

Perspective of patient

Patient satisfaction surveys are a key qualitative measure from a patient perspective. Patients may not have clinical judgment from doctors and often assess quality on the basis of attention and attitudes of practitioners, among other things. As a result, patient satisfaction surveys have become a rather controversial measure of quality care. Advocates argue that patient surveys can provide the doctors with the necessary feedback to help improve their practice. In addition, patient satisfaction is often correlated with patient involvement in decision making and may improve patient-centered care. Evaluation of patient care can identify opportunities for improvement in care, reduce costs, monitor health plan performance, and provide comparisons across health care institutions. Opponents of the patient satisfaction survey are often unsure that the data is reliable, that cost does not justify the cost, and that what is measured is not a good quality indicator.

The Department of Health and Human Services based 30 percent of hospital Medicare replacement on patient satisfaction survey scores on the survey, known as the Consumer Assessment Hospital of Healthcare Providers and Systems (HCAHPS). "Starting in October 2012, the Affordable Care Act implements a policy that holds 1 percent of Medicare's total reimbursement - about $ 850 million - from hospitals (that percentage will double by 2017.) Every year, only hospitals with patient satisfaction scores the height and size of certain basic care standards will make the money back, and the best players receive bonuses from the pool. "

Technology and security perspectives

Technology can also influence the patient's perception of the quality of health care. The 2015 survey of cancer patients showed that those who had a more positive attitude toward health information tools from their providers used more tools and then had higher quality perceived care from their providers. The same survey also shows that those who believe their service providers act safer and have lower privacy concerns are more likely to have a positive attitude toward health information tools from their providers and thus a higher perception of the care they receive.

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History in the United States

In the early 19th century, health care quality improvement interventions were implemented in an effort to improve health care outcomes. Improving the quality of health services was further developed in the 1900s, with important improvements to the modern field of quality improvement that occurred in the late 1960s.

In the early 1900s, Dr. Ernest Codman of Massachusetts General Hospital suggests a measure that tracks every hospital patient to determine the effectiveness of their care. His suggestion of a system for tracking patient care to determine the quality and standard of care in a hospital dubbed him one of the earliest advocates of health quality. Shortly after, influenced by the work of Dr. Codman, the American College of Surgeons (ACS) was founded. In 1918, the ACS developed the Minimum Standards for Hospitals, which are one page. As a result of the 1918 Minimum Standards for Hospitals, the ACS began conducting on-site checks to determine whether they were normal. During the first inspection of 692 hospitals, only 13% met the minimum standards.

In 1945, Joseph Juran and Edwards Deming founded the Quality Improvement (QI) as a formal approach to analyze systematic efforts to improve performance. In particular, Deming, a philosopher, places emphasis on the macro level of organizational management and improvement through a systems approach. Juran, on the other hand, is planning, controlling, and improving quality at the micro level. He encourages questions, believes that they deepen understanding of the problem and lead to increased effectiveness in planning and taking action. Together, their work affects the quality of public and private American organizations in health and industry to government and education.

The Joint Commission on Hospital Accreditation (JCAH) was established in 1951 as an independent and nonprofit organization that provides voluntary accreditation for hospitals that meet minimum quality standards. JCAH is formed by the combined forces of the American College of Physicians, the American College of Surgeons, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. In 1952, ACS officially transferred Hospital Standardization Program to JCAH. JCAH began to charge for surveys in 1964.

The Social Security Amendment of 1965 was passed by Congress in an attempt to provide hospitals accredited by JCAH "considered status". Thus, the same hospital is said to meet the requirements required to participate in Medicare and Medicaid. Until 1966, when Avedis Donabedian, MD published his book "Evaluating the Quality of Medical Care", the study of the quality of health care is based on structures (eg, licensing, staffing levels, accreditation). Donabedians show a new perspective on health quality analysis based on structure, processes, and outcomes.

The National Academy of Sciences established the Institute of Medicine (IOM) in 1970. IOM, a non-profit and independent scientific adviser, was created to improve health on a national scale. The Accreditation Association for Outpatient Health Care (AAAHC) was established in 1970 to improve the quality of health care for patients served by outpatient health care organizations by setting ambulatory health accreditation standards, similar to JCAH. The Agency for Research and Quality of Health (AHRQ) was created in 1989 to improve the quality, safety, efficiency, and effectiveness of health care through research.

In 1990, the National Committee for Quality Assurance (NCQA) was entrusted to offer an accreditation program for managed care organizations. NCQA was established as an independent non-profit organization dedicated to improving the quality of health care through accreditation and performance measurement. In 1991, Non-profit Institute for Health Improvement (ILHI). Don Berwick was founded. Rather than just focusing on improving the quality of national health care, IHI is campaigning but nationally and worldwide. Directing the focus to the patient as a consumer, the National Patient Safety Foundation was established in 1996. In 1998, with the presidential directive, the Coordinator of the Tasks for Quality Coordination (QuIC) was created to improve the coordination of federal agencies working to improve quality care.. When IOM published the To Err is Human in 1999, revealing a high level of medical mortality, QuIC publishes a report that takes inventory of regulatory and legislative initiatives that seek to correct problems surrounding medical errors. Also in 1999, the National Quality Forum was established. Nonprofit private forums aim to standardize health care delivery and quality measurement. Responding to patient safety issues discussed in For Err is Human , the United States enacted the Law of Safety and Patient Quality Improvement in 2005.

Recently, the focus on quality improvement has been the emergence of health information technology (eg, electronic health records and patient-centered care.Thus, the formation of Patient-Centered Medical Homes (PCMH) began to gain popularity in 2007. Under PCMH, between primary personal care physicians and specialists improve coordination and integration of care for patients. Furthermore, technology is used to safeguard personal health information and improve quality and safety. Since 2007, various studies have demonstrated the various benefits of PCMH in improving healthcare quality. Organizations

Health care quality: Using health care performance ratings - YouTube

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that determine the quality

Organizations working to establish standards and measures for the quality of health care including Government health systems; private health systems, accreditation programs such as for hospital accreditation, health associations, or those wishing to establish international health accreditation; philanthropic foundation; and health research institutions. These organizations seek to define the concept of quality in health care, measure that quality, and then encourage quality measurements on a regular basis so as to provide evidence that effective health interventions.

In the United States

Some organizations have established measures to determine quality because service providers, patients and payers have different views and expectations of quality. This complicated situation creates challenges because often quality measures can not be compared across the organization and there are issues of transfer and merging across systems. Consequently, when measuring the quality of health care for this reason, high quality longitudinal provides a substantive framework from which healthcare researchers can work.

The Medicare and Medicaid Service Centers (CMS) design quality evaluations, collect quality, and manage funding for Medicare and Medicaid central government programs. In 2001, CMS initiated several quality initiatives including, but not limited to: Home Health Quality Initiatives, Hospital Based Purchasing Programs, Hospice Quality Reporting Programs, Quality Inpatient Reports, and Quality Hospital Care Long Term Reporting. CMS established initiatives to measure and improve the quality of care for Medicaid and CHIP beneficiaries for services provided under the umbrella of Screening, Diagnosis and Early Periodic Care Program (EPSDT), including maternal and infant health, home and community-based services, preventive care, health, patient safety, external quality reviews, and improved treatment transitions. For wider quality control, CMS also created Hospital Compare, which is a major public reporting program that measures and also reports on treatment and outcome processes for various health care interventions including heart failure, pneumonia, and acute myocardial infarction.

The Health Research and Quality Agency (AHRQ) is a central government organization that gathers public reports on health quality evaluations to improve the safety and quality of health care. AHRQ works closely with the US Department of Health and Human Services to ensure that evidence is understood and used by the medical community to improve the quality of care. To fulfill its mission, AHRQ contracts with several subsites.

CMS and AHRQ have collectively established the Hospital Consumer Surveys Survey and Health System Survey (CAHPS). The CAHPS survey collects a uniform measure of patient perspectives on various aspects of care they receive in inpatient settings. The results are published on the Compare Hospital website, which can be used by health care organizations and researchers to improve the quality of their services. Buyers, consumers, and researchers can also use data to make informed business choices.

Joint Commission Accreditation for Health Organizations (JCAHO) is a nonprofit organization that assesses quality at various levels by examining health care facilities for compliance with clinical guidelines, compliance with rules and regulations for medical staff skills and qualifications, reviewing medical records to evaluate processing and searching care medical errors, and check the building for security code violations. JCAHO also provides feedback and opportunities for improvement, while simultaneously issuing quotes for closure of facilities deemed non-compliance with standard quality standards set.

In the United Kingdom

In the UK, health care is funded and sent through the National Health Service (NHS) and quality is overseen by a number of different agencies. Monitor, a non-departmental public agency sponsored by the Department of Health, is a health sector regulator for healthcare in the UK. It works closely with the Commission on Quality of Care (CQC) a government-funded independent agency responsible for overseeing the quality and safety of health and social care services in the UK, including hospitals, nursing homes, dentists and general practitioners and other nursing services. The National Institute for Health Research (NIHR) has a number of infrastructure programs that support quality in health care, including the Collaboration for Leadership in Applied Health Research and Treatment (CLAHRCs).

The medical profession in the UK has its own membership and association of arrangements. These include the General Medical Council (GMC), the Nursing and Midwifery Board, the General Dental Council and the Health and Nursing Professionals Council. Other health quality organizations include the Health Care Quality Improvement Partnership (HQIP), charities and limited companies founded by the Royal College of Nursing Academy of Medicine, National Voices; and Healthwatch, the official national body working with groups across the country to ensure that the patient's view is at the heart of decisions about the health care system.

A number of health think tanks, including the King's Fund, the Nuffield Trust and the Health Foundation offer analysis, resources, and comments about the quality of health care. In 2013, the Nuffield Trust and Health Foundation launched QualityWatch, an independent research program that tracks how the quality of healthcare services in the UK is changing in response to limited rearrangements and funding.

In India

Healthcare efforts in India are starting to gain strength. Some organizations involved in this work include the National Accreditation Board for Hospitals & amp; Healthcare providers (NABH), Patient Safety Alliances, ICHA and National Health System Resource Center (NHSRC). The All India Institute of Medical Sciences also leads some health quality work in India and in the SEARO region.

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References

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Health care quality

Sabtu, 09 Juni 2018