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a




 
Quality of care has been defined by the Institute of Medicine (IOM)as ³the degree
to which health services for individuals and populations increase the likelihood of
desired health outcomes and are consistent with current professional
knowledge.´ In a major report published in 2001 (³Crossing the Quality Chasm´
(1)), the IOM set forth six aims for a quality health care system (
):
patient safety (freedom from medical errors), patient-centeredness (a focus on
the patient¶s needs and wishes), effectiveness (the degree to which care is
consistent with the best available evidence), efficiency (the degree to which care
does not squander scarce resources), timeliness (the degree to which care is
delivered as promptly as is required for a given situation), and equity (the degree
to which care is fairly delivered, with no disparities, for example, by race,
socioeconomic class, or insurance status).


  
 

1. Patient Safety
2. Patient-Centeredness
3. Effectiveness
4. Efficiency
5. Timeliness
6. Equity

Even though the ³six aims´ make it clear that quality of care goes well beyond
simply providing evidence-based care, evidence does provide the scaffolding on
which most quality measurement and improvement activities are built. 

shows the yearly growth in the numbers of published randomized clinical trials (a
study in which alternative strategies are pitted against each other, with patients
randomly allocated to the treatment ³arms´ to ensure that the results are due to
differences in the clinical strategy rather than differences in the patients
themselves), the gold standard for evidence-based medicine. This type of
research has helped define evidence-based practices in many areas of medicine,
from preventive strategies for a healthy 52-year-old healthy woman to the
treatment of the 30-year-old man with liver failure or the infant born 10 weeks
prematurely.


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