Quality of care is a term most commonly used, in my experience, in relation to health care. But what does it mean?

The US-based Institute of Medicine defines quality as "the degree to which health services for individuals and populations increase the likelihood of desired health care outcomes and are consistent with current professional knowledge". I'd prefer a more inclusive definition, and I'm not alone in arguing that quality health care should:

Be accessible
Health care should be available to all patients when they need it and where they need it, regardless of their personal characteristics (race, age, sexual orientation, religion, etc). Note that this implies that health care should be available on the basis of need, not ability to pay. Unfortunately, in countries which do not have universal health care, like the US, this is not always the case: those without health insurance are much less likely to be able to access care at all. Note too that in rural and remote areas accessibility may be compromised: people may have to travel long distances to visit physicians or hospitals. And other things can stand in the way of accessibility: as an example, women caring for children or ill relatives may be unable to take the time away from their caregiving to get health care for themselves.

Be appropriate
The intervention given by the health care provider (doctor, nurse, midwife, naturopath, whatever) should be the "right" one. This too is not easy to achieve. First, the health care provider must correctly diagnose the problem, which is sometimes difficult. Then they must have knowledge of, and access to, the "correct" intervention (that is, the intervention recommended for use by current practice standards). In poverty-stricken areas, refugee camps, or war zones they may not have that access. Note too that the care and intervention provided may be excellent, but if the patient does not comply with the treatment regimen - for example, cannot afford to buy the medicine, or refuses to take it - the best quality care in the world will be all but useless.

Build a respectful relationship
There should be at least a modicum of trust and understanding between the health care provider and the patient. Once upon a time this might not have mattered so much, when doctors were seen as infallible authorities to be listened to and obeyed. But times have changed. Consumers are doing their own research about health and health care and asking their providers questions about conditions and treatment options. Health care providers have, by and large, responded by providing more fulsome information to patients - some more grudgingly than others. Undoubtedly, a good relationship helps patients trust their doctors and thereby probably improves compliance with treatment regimens.

Try to heal or cure
It isn't always possible to heal someone, but if it is, quality health care should do it. At the very least, it should not cause further harm to the patient.

In recent decades in the US and elsewhere, health care providers and funders (primarily governments and insurance companies, but also private hospital corporations and health professional organizations) have begun to collect data on health system (and, less commonly, individual health providers') performance, and publish this data in health "report cards". The purpose of these report cards is to compile objective measures of quality of care, sometimes supplemented by subjective measures such as patients' perceptions of the care they received. What these endeavours have made clear is that it is very difficult to collect accurate, reliable, relevant data, and even more difficult to interpret it. Still, the goal of understanding and improving quality of care is a good one, and can help give teeth to documents such as a Patient Bill of Rights.


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