Journal of the American Academy of Orthopaedic Surgeons, Vol. 8, No. 2, March/April 2000
Author: J. Daum, MD, Mark R. Brinker, MD, and David B. Nash, MD, MBA
Quality health care has many definitions. Among those definitions is "care that consistently contributes to the improvement or maintenance of the quality and/or duration of life." The current evolution in health care has been fueled
by three necessities frequently demanded by payers and employers: improvement
in access, lowering of cost, and definition and quantification of the quality
of care. This evolution has been facilitated by the so-called industrialization of
medicine. This concept includes the adoption of industrial economic principles
and techniques that facilitate the measurement of processes and outcomes.
Quality health care is currently recognized as health care that is characterized
by three elements: the use of practice guidelines or standards, the implementation
of continuous quality improvement techniques, and the use of outcome
determination and management. Practice guidelines demand the adoption of
evidence-based principles in evaluation and care, as well as minimization of
variations in evaluation and care. Continuous quality improvement seeks to
determine why variations in processes of care occur and then to minimize those
variations. Outcomes may be measured in terms of both very objective and
very subjective variables and also on the basis of cost-efficiency. Most tools
currently used to quantify outcomes, especially in orthopaedics, involve measurements
of general health and of specific body part or organ system function.
This evolution in health care is producing significant alterations in methods of
traditional health-care delivery. The accumulating evidence indicates that
these changes, although frequently unpopular, are improving the quality of
health care.
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