Maintaining the highest possible quality of care is a vital part of efficient health system operations. Without quality control the services offered by even the most technologically advanced and skilled healthcare providers will be compromised and patients, among others, will suffer the consequences. Quality of care is a variable with multiple dimensions, each of which requires consistent evaluation and subsequent corrective action when appropriate. The measurement of care quality is difficult because the interaction between variable characteristics can vary from setting to setting. Accordingly, it is important to consider the specific environment in which healthcare services are being provided while assessing care value.
Patient perceptions and treatment outcomes can be easily mistaken to be the only two significant sources of information regarding the quality of care they received. The two factors are undoubtedly important to consider when making such an evaluation, but they must be accompanied by a host of other indicators if the measurement process is intended to be comprehensive as it should. Restricting interpretations to patient perceptions and outcomes will not produce results that can adequately account for the complexity of healthcare operations. Also, each of these supposedly vital factors can be full of bias as patient perceptions are highly subjective and treatment outcomes can only describe a very narrow part of the healthcare system, so more measurements are required to corroborate interpretations that made be drawn from this evidence.
A potentially powerful method of health care quality assessment is found in the hospital standardized mortality ratio (HSMR). The approach is clearly focused on the hospital setting and includes a salient variable of measurement. However, it may be a concern that the HSMR is too narrow because it is apparently fixated on a treatment outcome. Fortunately this issue is addressed by the standardization techniques used to include a multitude of factors in the analysis. Mortality is not measured by straightforward death counts or ratios in the HSMR and is instead formed by combining a multitude of scores from case-mix variables that include patient diagnosis, sex, age, admission urgency, length of stay, month of admission, social deprivation, comorbidity, and referral source. This method has been implemented in the Netherlands and demonstrates potential as a good starting point for a robust assessment of care quality in the hospital setting.
Physicians are different from hospitals because they are single people rather than an organization. Still, the role of the physician is critical in the supply of many health care services throughout the whole system and should be evaluated as a highly variant position. Similarly to the HSMR, the quality indicator is not a simple summation or percentage but instead should be compiled from a multitude of scores that were obtained from variables that ultimately influence the particulars of the setting. For example, the service process is affected by the appropriateness of the service, prognosis, treatability, and prevention availability. A valid measurement of physician inpatient service quality will account for these influences, along with perceptions of patients and treatment outcomes. The previous variables affect inpatient care the most, while outpatient care assessments may aim to consider the influence of screening processes, length and severity of illness, access, communication, and education.
The quality of health care services can only be optimized when regular and robust assessments are conducted. Without thorough evaluations there is little chance of effectively addressing the shortcomings of a system. Consideration must be made for the specific healthcare setting as well as a multitude of variables that can otherwise be confounding influences on the assessment process.