PEPs - Clinical Quality and Evidence

Module 1 - Clinical Quality

Measuring clinical quality

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Here we focus on the measurement of clincal quality as it relates to healthcare.


“You can’t improve that which you can not measure”

(Kenneth Kizer, Kaiser Permanente, USA, Personal Communication)


Measuring clinical quality requires a lot more than audit. Audit remains a very important component. The overall measurement of clinical quality is best done using the following domains ¹ :


Structure


Refers to the inherent characteristics which are associated with higher quality (e.g.):

  • Procedure volumes
  • Advanced IT systems
  • Nurse staffing ratios
  • Stroke service

Processes

  • Do you comply with evidence-based care guidance?
  • Administration of aspirin and B blockers with acute coronary syndrome
  • Compliance with desirable practices such as frequent determination of HbA1c in diabetics

Outcomes

  • some general ones
  • some sector or condition specific

The three main dimensions of clinical quality, Effectiveness, Safety and Patient Experience can be integrated with the three domains, using the following grid. This is not to say that the other dimensions of quality, Efficiency, Accessibility and Equity, are unimportant. They are, but for simplicity it is easier to look at the following 3x3 grid. You may well be able to construct your own 3x6 grid, which would be quite valid.

Teacher's Comment

Other examples?  While you are completing this module, you could read about interventions (like SBAR) and then consider in which domains these can be implemented and measured.

References
  1. Donabedian A (1966). ‘Evaluating the quality of medical care’. The Milbank Memorial Fund Quarterly, vol 44, no 3, pt 2, pp 166–203.