Quality Health Care
What is Quality Health Care?
There are two alternative definitions of “Quality Health Care”:
- the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (The Institute of Medicine)
- the achievement of optimal physical and mental health through accessible, cost-effective care that is based on best evidence, is responsive to the needs and preferences of patients and populations, and is respectful of patients’ families, personal values and beliefs (The American Association of Family Physicians)
The Institute of Medicine (IOM) led the movement for Quality Health Care. Initially, it identified three types of Quality Health Care problems: overuse, underuse and misuse. In their 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM provided guidance for improving the health care system as set forth below:
Six Aims of Quality Health Care
- Safe – avoiding injuries to patients from care that is intended to help them
- Effective – providing services based on scientific knowledge
- Patient-centered – providing care that is responsive to individual patient preferences, needs and values and assuring that patient values guide all clinical decisions
- Timely – reducing waits and sometimes harmful delays for both those who receive care and those who give care
- Efficient – avoiding waste, including waste of equipment, supplies, ideas, and energy
- Equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status.
Simple Rules for the 21st Century Health Care System
|Current Approach||New Rule|
|Care is based primarily on visits.||Care is based on continuous healing relationships.|
|Professional autonomy drives variability.||Care is customized according to patient needs and values.|
|Professionals control care.||The patient is the source of control.|
|Information is a record.||Knowledge is shared and information flows freely.|
|Decision making is based on training and experience.||Decision making is evidence-based.|
|Do no harm is an individual responsibility.||Safety is a system property.|
|Secrecy is necessary.||Transparency is necessary.|
|The system reacts to needs.||Needs are anticipated.|
|Cost reduction is sought.||Waste is continuously decreased.|
|Preference is given to professional roles over the system.||Cooperation among clinicians is a priority.|
|Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington D.C.: National Academy Press.|
The State of Health Care in America
Around the world, the United States is known as the place to go to get the best health care. Our nation spends far more than any other country on health care, nearly two trillion dollars, 47% higher than the next country. 1 In 2002, the U.S. spent $5,267 spent per capita, 53% more than any other country. 2 Despite this enormous investment, the U.S. ranks lowest among industrialized nations in patient satisfaction. 3 In addition to having the highest health care expenditure, we have the highest qualified physicians and the best health technology, yet we remain abysmally deficient in the area of Quality Health Care. Ask anyone who has a chronic health problem and you are apt to hear a story reflecting one of poor Quality Health Care.
Quality Health Care is the number two health care issue in Congress, second only to access. In fact, it is access to qualityhealth care. Access means having the ability to pay for health care and to obtain it within a reasonable geographic area. To date, evaluations of access have not ensured that it is to quality health care. Thus, if quality is taken into consideration, the number of people lacking access would skyrocket.
Quality Health Care research has shown that the systemic problems need to be addressed first.
The U.S. health care system is widely known to be extremely complex and highly fragmented. Several years ago it was described as a broken system. Today it is called a non-system of health care.
And this non-system is the one we rely on when our parents fall ill, when our siblings and friends fall ill and when our children who depend on us fall ill.
PPC’s focus is on Young People with Chronic Conditions & Disabilities and the entire spectrum of the health care system. While most hospitals have engaged in some quality improvement efforts, physician practices and other outpatient care practices have yet to institute improvements. Furthermore, much of the work has been with adult health care and the Medicare population not with children and young adults, the group that has the most to gain from quality improvement.