qualityofcare

Quality of care refers to the degree to which health care services increase the likelihood of desired health outcomes and are consistent with current professional knowledge. It encompasses both the technical aspects of care and the interpersonal aspects of the patient experience. The concept is often analyzed through the Donabedian framework of structure, process, and outcome.

Key dimensions include safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity, as articulated by the Institute of Medicine. Other frameworks emphasize value: achieving the best outcomes at reasonable cost, with appropriate access.

Measurement includes clinical indicators (e.g., infection rates, medication errors), patient outcomes (mortality, functional status), safety metrics, patient-reported outcomes and experiences, and equity indicators. Data sources include medical records, registries, claims, and surveys. Challenges include attributing outcomes to care, data quality, and comparing across settings.

Improvement relies on quality improvement methodologies such as Plan-Do-Study-Act cycles, Lean and Six Sigma, standardized care processes, clinical guidelines, and shared decision making. Electronic health records and dashboards enable monitoring and feedback.

Governance involves providers, health systems, regulators, payers, and patients; accreditation and licensure standards help define minimum quality levels. In practice, quality of care is context-dependent and influenced by resources, population needs, and social determinants of health. Ongoing measurement and learning are essential to sustain improvement.