Quality Assurance of Health Services
INDEXCONTENTS Preface........................... Note on terminology.................. Introduction....................... 1. Conceptual framework of quality assurance Quality assurance as evaluation........ The framework ..................... Uses of the framework................. Health care as a production process........ Quality control in industry.......... Health care as production........... Analogy between industry and health care 2. The environment of quality assurance.............. Motivation of quality assurance.................. Ethical motives ....................... Safety motives.......................... Efficiency motives ....................... Sponsoring agencies ......................... Strategies to influence the quality of health services Education as a strategy for improving the quality of health services......................... The locus of quality assurance................... Quality assurance in primary care Expansion of the locus and focus of quality assurance 3. The concept of quality .............. The quality of health services.......... Components of quality ........... Quality for whom?.............. Distribution of quality............ Optimal quality................... Quality and costs............... Selection of the optimal qualitative level Logical quality.................... Reasons for poor logical quality .....3. The concept of quality (contd) Optimizing the yield of quality assurance...... Objectives of quality-related research and activities "Pure" research.................... Regulation ....................... Policy planning and programme evaluation . . Improving the quality of care........... Consumer protection................. Screening for fraud.................. The focus of quality assurance ............. The structural approach............... Evaluation of the structural approach...... The process approach ................ Evaluation of the process approach The outcome approach............... Evaluation of the outcome approach...... 4. Methodological issues ..................... Sources of information.................... Medical records ....................... Participatory observation................. Opinion of the patient................... Indirect methods ...................... Care to be analysed........................ Sampling............................... Criteria and standards Criteria of good care.................... Standards of good care .................. Methodological properties of the measuring instrument Validity............................. Reliability........................... Sensitivity Education for quality assurance......... Medical education...................... Education of the public.................. 5. Conclusions............................. References
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