Int J Qual Health Care-2001-Rubin-469-74

The institute of medicine iom in the us has dened

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Unformatted text preview: tcomes [3]. The Institute of Medicine (IOM) in the US has defined health care quality as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ [4]. The IOM’s definition and framework thus incorporate two of Donabedian’s three elements in a broad approach to measuring health care quality: (1) determining effects of health care on desired outcomes, including a relative improvement in health, and in consumer evaluations or experience of health care and (2) assessing the degree to which health care adheres to processes that are proven by scientific evidence, professional consensus to affect health, or that concur with patient preference [5–7]. The IOM has further suggested that health care should have the six aims of being effective, safe, patient-centered, timely, efficient, and equitable [4]. Whereas the aims of effectiveness and safety of health care are nearly universal, societies and cultures around the world differ more in how much they emphasize the additional aims of patient-centeredness, timeliness, efficiency, and equity. Process of care measures of quality assess the degree to which providers perform health care processes demonstrated to achieve the desired aims and the degree to which they avoid processes that avert the desired aims. Public agents and payers’ ultimate concern rests with providers’ impact on patient outcomes, and most of their measures of quality to date have focused on this. For example, the Center for Medicare and Medicaid Services (CMS formerly the Health Care Financing Administration, HCFA), which administers the Medicare entitlement program for the elderly in the US, began by releasing mortality rates for hospitals [8]. The need for risk adjustment when comparing different providers became evident, and subsequent efforts attempted this. For example, several US state governments including New York, Pennsylvania, and California provided their citizens with publicly available report cards containing riskadjusted mortality rates for...
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