Quality of care

Quality assurance is a continuous cycle of evaluating clinical care. To achieve this, the quality assurance committee should: assess or evaluate the quality of care using a variety of data sources to identify problems or shortcomings in the delivery of care and make recommendations to overcome these deficiencies.

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.


Patient-centered care

Timely – reducing waits and sometimes harmful delays for both those who receive and those who give care.


Equitable – providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status.

Quality of care measurement was a late addition to managed care. As a small specialty, neurosurgery quality of care metrics have a low priority for Medicare and other healthcare payers. Frequency of complications of glioma surgery derived from a large administrative database can be used as a quality measure, but the results may be inaccurate and inadequate. Prospective voluntary outcome registries offer a better alternative 1).

Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are metrics for quality of care and are linked to reimbursement. The prevalence of PSIs/HACs may impact access to health care for certain conditions.

The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported metrics that illustrate the overall quality of care provided at an institution.

Bean JR. Neurosurgical Quality Metrics: Seeking the Right Question. World Neurosurg. 2015 Jun 10. pii: S1878-8750(15)00711-1. doi: 10.1016/j.wneu.2015.06.004. [Epub ahead of print] PubMed PMID: 26072459.
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