Evaluating the Quality of Health Care

3. Defining Quality of Care

There are many definitions of quality of care, but the Institute of Medicine (IOM) has proposed one that captures well the features of many other definitions and that has received wide acceptance (Institute of Medicine, 2001; Lohr & Committee to Design a Strategy for Quality Review and Assurance in Medicare, 1990):

“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

As compelling as that definition is, it does not provide much guidance to a researcher interested in developing a measure or set of measures. A subsequent IOM report specified seven aims of a high quality medical care system that are more specific (Institute of Medicine, 2001):

• Safe – avoiding injuries to patients from the care that is supposed to help them.
• Effective – providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse).
• Patient-centered – providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
• Timely – reducing waits and sometimes harmful delays for both those who receive and those who give care.
• Efficient – avoiding waste, in particular 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, and socioeconomic status.