Subject(s)
Health Services Research , Home Care Services/standards , Quality Assurance, Health Care/organization & administration , Acute Disease/classification , Chronic Disease/classification , Colorado , Humans , Outcome Assessment, Health Care , Pilot Projects , Program Development , Severity of Illness Index , United StatesABSTRACT
Quality assurance in health care has been an evolutionary process, beginning thousands of years ago with expressions of concern about how to care for other human beings properly. Perhaps the most notable of these expressions were those recorded by Hippocrates in his discourses on medical ethics. In more recent times, we easily are able to trace the evolution of quality assurance beliefs from emphases placed first on structure, then on process, then on a combination of structure and process, to now when we see a gradual awakening to the importance of a third element, patient outcomes. Quality, in any endeavor, does not just happen. It is, rather, the result of trial and error, practice, and hard work. In short, it is the result of learning, and hand-in-hand with learning goes communicating. By taking patient outcomes into consideration, we create a feedback system, a communication process conducive to learning in that it effectively opens up the avenues joining the three elements of health care: (1) structure, (2) process, and (3) patient outcome. We live in an era of fast-paced change where time is a precious commodity; we cannot, especially in the health care industry, afford to waste it. In seeking to formulate a systematic approach to quality assurance, focusing on only one of the three components of health care identified to date would be foolish. Effective change is based on effective communication, and from years of experience, it is clear that the best approach to high quality assurance is one that takes all elements into account.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Outcome and Process Assessment, Health Care/standards , Quality Assurance, Health Care/standards , Humans , Outcome and Process Assessment, Health Care/organization & administration , Outcome and Process Assessment, Health Care/trends , Quality Assurance, Health Care/organization & administration , Quality Assurance, Health Care/trendsABSTRACT
Increased use of home care services, and the provision of more sophisticated care to acutely ill patients, have prompted concern about quality assurance in home settings. A conceptual framework is proposed to assess home health-care quality based on two premises: outcome, process, and structural measures, first, are required to evaluate quality accurately; classification of patients into quality indicator groups (QUIGs), second, permits specification and use of more practical and valid quality measures. The framework may prove useful because measures are related directly to patient conditions, services rendered, and treatment objectives. Further reliability and validity testing of the QUIGs and a system of operational quality measures are currently underway.
