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Health care quality

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

Health care quality is the degree 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 relationships between quality, cost, and accessibility of health care within a community. Researchers measure health care quality to identify problems caused by overuse, underuse, or misuse of health resources. In 1999, the Institute of Medicine released six domains to measure and describe quality of care in health:

While essential for determining the effect of health services research interventions, measuring quality of care poses some challenges due to the limited number of outcomes that are measurable. Structural measures describe the providers' ability to provide high quality care, process measures describe the actions taken to maintain or improve community health, and outcome measures describe the impact of a health care intervention. Furthermore, due to strict regulations placed on health services research, data sources are not always complete.

Assessment of health care quality may occur on two different levels: that of the individual patient and that of populations. At the level of the individual patient, or micro-level, assessment focuses on services at the point of delivery and its subsequent effects. At the population level, or macro-level, assessments of health care quality include indicators such as life expectancy, infant mortality rates, incidence, and prevalence of certain health conditions. Quality assessments measure these indicators against an established standard. The measures can be difficult to define in health care.

Doctor quality has been shown to reduce mortality and reduce cost per patient, while patient evaluations were found to not relate with doctor quality.

Quality frameworks are essential tools for understanding and improving health systems. They help define, prioritize, and implement health system goals and functions. Among the key frameworks is the World Health Organization's building blocks model, which enhances health quality by focusing on elements like financing, workforce, information, medical products, governance, and service delivery. This model influences global health evaluation and contributes to indicator development and research.

The Lancet Global Health Commission's 2018 framework builds upon earlier models by emphasizing system foundations, processes, and outcomes, guided by principles of efficiency, resilience, equity, and people-centeredness. This comprehensive approach addresses challenges associated with chronic and complex conditions and is particularly influential in health services research in developing countries. Importantly, recent developments also highlight the need to integrate environmental sustainability into these frameworks, suggesting its inclusion as a guiding principle to enhance the environmental responsiveness of health systems.

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

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