Health care quality is a level of
value
Value or values may refer to:
Ethics and social
* Value (ethics) wherein said concept may be construed as treating actions themselves as abstract objects, associating value to them
** Values (Western philosophy) expands the notion of value beyo ...
provided by any
health care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
resource, as determined by some measurement. As with
quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good
quality of life
Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
,
cure
A cure is a substance or procedure that ends a medical condition, such as a medication, a surgical operation, a change in lifestyle or even a philosophical mindset that helps end a person's sufferings; or the state of being healed, or cured. The ...
illnesses when possible, to extend
life expectancy
Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, current age, and other demographic factors like sex. The most commonly used measure is life expectancy at birth ...
, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by
medical diagnosis
Medical diagnosis (abbreviated Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. The information re ...
, a decrease in the number of
risk factors
In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.
Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...
which people have following
preventive care
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
, or a survey of
health indicators
Health indicators are quantifiable characteristics of a population which researchers use as supporting evidence for describing the health of a population. Typically, researchers will use a survey methodology to gather information about a populati ...
in a population who are accessing certain kinds of care.
Definition
Health care quality is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes.
Quality of care plays an important role in describing the
iron triangle of health care relationships between quality, cost, and accessibility of health care within a community.
Researchers measure health care quality to identify problems caused by
overuse, underuse, or misuse of health resources.
In 1999, the
Institute of Medicine
The National Academy of Medicine (NAM), formerly called the Institute of Medicine (IoM) until 2015, is an American nonprofit, non-governmental organization. The National Academy of Medicine is a part of the National Academies of Sciences, E ...
released six domains to measure and describe quality of care in health:
# safe – avoiding injuries to patients from care that is intended to help them
# effective – avoiding overuse and misuse of care
# patient-Centered – providing care that is unique to a patient's needs
# timely – reducing wait times and harmful delays for patients and providers
# efficient – avoiding waste of equipment, supplies, ideas and energy
# equitable – providing care that does not vary across intrinsic personal characteristics
While essential for determining the effect of
health services research
Health services research (HSR) became a burgeoning field in North America in the 1960s, when scientific information and policy deliberation began to coalesce. Sometimes also referred to as health systems research or health policy and systems resear ...
interventions, measuring quality of care poses some challenges due to the limited number of outcomes that are measurable.
Structural measures describe the providers' ability to provide high quality care, process measures describe the actions taken to maintain or improve community health, and outcome measures describe the impact of a health care intervention.
Furthermore, due to strict regulations placed on health services research, data sources are not always complete.
Assessment of health care quality may occur on two different levels: that of the individual patient and that of populations. At the level of the individual patient, or micro-level, assessment focuses on services at the point of delivery and its subsequent effects. At the population level, or macro-level, assessments of health care quality include indicators such as life expectancy, infant mortality rates,
incidence, and
prevalence
In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of certain health conditions.
[Shi L, Singh DA. Delivering Health Care in America: a Systems Approach. 6th ed. Sudbury, MA: Jones and Bartlett; 2015]
Quality assessments measure these indicators against an established standard. The measures can be difficult to define in health care.
Methods to assess and improve
The
Donabedian model is a common framework for assessing health care quality and identifies three domains in which health care quality can be assessed: structure, process, and outcomes.
All three domains are tightly linked and build on each other. Improvements in structure and process are often observed in outcomes. Some examples of improvements in process are: clinical practice guidelines, analysis of cost efficiency, and risk management, which consists of proactive steps to prevent medical errors.
Cost Efficiency
Cost Efficiency
Cost efficiency (or cost optimality), in the context of parallel computer algorithms, refers to a measure of how effectively parallel computing can be used to solve a particular problem. A parallel algorithm is considered cost efficient if its asy ...
, or cost-effectiveness, determines whether the benefits of a service exceed the cost incurred to provide the service.
A health care service is sometimes not cost efficient due to either
overutilization
Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate.
In the United States, where health care costs are the highest as a percentage of GDP, overuse was the ...
or underutilization. Overutilization, or overuse, occurs when the value of health care is diluted with wasted resources. Consequently, depriving someone else of the potential benefits from obtaining the service. Costs or risks of treatment outweigh the benefits in overused health care. In contrast, underutilization, or underuse, occurs when the benefits of a treatment outweigh the risks or costs, but it is not used.
There are potential adverse health outcomes with underutilization. One example is the lack of early cancer detection and treatment which leads to decreased cancer survival rates.
Critical Pathways
Critical Pathways are outcome-based and patient-centered case management tools that take on an interdisciplinary approach by "facilitating coordination of care among multiple clinical departments and caregivers".
Health care managers utilize critical pathways as a method to reduce variation in care, decrease resource utilization, and improve quality of care. Using critical pathways to reduce costs and errors improves quality by providing a systematic approach to assessing health care outcomes. Reducing variations in practice patterns promotes improved collaboration among interdisciplinary players in the health care system.
Health professional perspective
The quality of the health care given by a health professional can be judged by its outcome, the technical performance of the care and by interpersonal relationships.
"Outcome" is a change in patients' health, such as reduction in pain, relapses, or death rates.
Large differences in outcomes can be measured for individual medical providers, and smaller differences can be measured by studying large groups, such as low- and high-volume doctors. Significant initiatives to improve healthcare quality outcomes have been undertaken that include clinical practice guidelines, cost efficiency, critical pathways, and risk management.
Clinical Practice Guideline "Technical performance" is the extent to which a health professional conformed to the best practices established by
medical guidelines
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practice ...
.
Clinical practice guidelines, or medical practice guidelines, are scientifically based protocols to assist providers in adopting a "best practice" approach in delivering care for a given health condition.
Standardizing the practice of medicine improves quality of care by concurrently promoting lower costs and better outcomes. The presumption is providers following medical guidelines are giving the best care and give the most hope of a good outcome.
Technical performance is judged from a quality perspective without regard to the actual outcome - so for example, if a physician gives care according to the guidelines but a patient's health does not improve, then by this measure, the quality of the "technical performance" is still high.
For example, a Cochrane review found that computer generated reminders improved doctors' adherence to guidelines and standard of care; but lacked evidence to determine whether or not this actually impacted patient centered health outcomes.
Risk Management
Risk management consists of "proactive efforts to prevent adverse events related to clinical care" and is focused on avoiding medical malpractice.
Health care professionals are not immune to lawsuits; therefore, health care organizations have taken initiatives to establish protocols specifically to reduce malpractice litigation.
Malpractice concerns can result in defensive medicine, or threat of malpractice litigation, which can compromise patient safety and care by inducing additional testing or treatments. One widely used form of defensive medicine is ordering costly imaging which can be wasteful. However, other defensive behaviors may actually reduce access to care and pose risks of physical harm.
Many specialty physicians report doing more for patients, such as using unnecessary diagnostic tests, because of malpractice risks.
In turn, it is especially crucial that risk management approaches employ principles of cost efficiency with standardized practice guidelines and critical pathways.
Patient perspective
Patient satisfaction surveys are the main qualitative measure of the patient perspective. Patients may not have the clinical judgement of physicians and often judge quality on the basis of practitioner's concern and demeanor, among other things. As a result, patient satisfaction surveys have become a somewhat controversial measure of quality care. Proponents argue that patient surveys can provide needed feedback to physicians to assist on improving their practice. In addition, patient satisfaction often correlates with patient involvement in decision making and can improve patient-centered care. Patients' evaluation of care can identify opportunities for improvement in care, reducing costs, monitoring performance of health plans, and provide a comparison across health care institutions. Opponents of patient satisfaction surveys are often unconvinced that the data is reliable, that the expense does not justify the costs, and that what is measured is not a good indicator of quality.
The
Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
bases 30 percent of hospitals' Medicare reimbursement on patient satisfaction survey scores on a survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). "Beginning in October 2012, the Affordable Care Act implemented a policy that withholds 1 percent of total Medicare reimbursements—approximately $850 million—from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and top performers receive bonuses from the pool."
Technology and security perspective
Technology also may affect patients' perception of health care quality. A 2015 survey of cancer patients shows that those who have a more positive attitude towards the health information tools from their providers use the tools more and subsequently have a higher perceived care quality from their provider. The same survey also shows that those who believe their provider acts more securely and have a lower level of privacy concern are more likely to have a positive attitude towards the health information tools from their providers and thus a higher perception of the care they received.
History in the United States
As early as the 19th century, healthcare
quality improvement
Quality management ensures that an organization, product or service consistently functions well. It has four main components: quality planning, quality assurance, quality control and quality improvement. Quality management is focused not o ...
interventions were implemented in an effort to improve healthcare outcomes. Healthcare quality improvement further developed in the 1900s, with notable improvements for the modern field of quality improvement taking place in the late 1960s.
In the early 1900s,
Dr. Ernest Codman of Massachusetts General Hospital suggested a measure that tracked each patient of the hospital to determine effectiveness of their treatment. His proposal of a system to track patient care to determine quality and standard of hospital care dubbed him one of the earliest advocates of healthcare quality.
Shortly after, influenced by the work of Dr. Codman, the
American College of Surgeons (ACS) was founded. In 1918, the ACS developed the Minimum Standard for Hospitals, which was one page. As a result of the 1918 Minimum Standard for Hospitals, ACS began performing on-site inspections of hospitals to determine if they were up to par. During the first on-site inspections of 692 hospitals, only 13% met the minimum standard.
In 1945,
Joseph Juran
Joseph Moses Juran (December 24, 1904 – February 28, 2008) was a Romanian-born American engineer and management consultant. He was an evangelist for quality and quality management, having written several books on those subjects. He was the bro ...
and
Edwards Deming
William Edwards Deming (October 14, 1900 – December 20, 1993) was an American engineer, statistician, professor, author, lecturer, and management consultant. Educated initially as an electrical engineer and later specializing in mathematica ...
established Quality Improvement (QI) as a formal approach to analyzing systematic efforts to improve performance.
Specifically, Deming, a philosopher, placed emphasis on the macro level of organizational management and improvement via a systems approach. Juran, on the other hand, strategized quality planning, control, and improvement at the micro level. He encouraged questions, believing they deepened understanding of problems and led to increased effectiveness in planning and taking action. Together, their work influenced quality of both American public and private organizations in fields from healthcare and industry to government and education.
The
Joint Commission on Accreditation of Hospitals (JCAH) was established in 1951 as an independent and non-profit organization that provided voluntary accreditation to hospitals that met minimum quality standards.
JCAH was formed by the combined forces of the
American College of Physicians
The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults.Sokanu "What is an Internist?" Retrieved October 20, 2014 With 161,000 members, ACP is the largest ...
, the
American College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913.American College of Surgeons Online "What is the American College of Surgeons?"/ref>
See also
*American College of Physicians
The American College o ...
, the
American Hospital Association, the
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's state ...
, and the
Canadian Medical Association. In 1952, the ACS formally transferred its Hospital Standardization Program to JCAH. JCAH began to charge a fee for surveys in 1964.
The
Social Security Amendments of 1965
The Social Security Amendments of 1965, , was legislation in the United States whose most important provisions resulted in creation of two programs: Medicare and Medicaid. The legislation initially provided federal health insurance for the elder ...
were passed by Congress in an attempt to grant hospitals accredited by JCAH "deemed status". As such, those same hospitals were said to meet the necessary requirements to participate in
Medicare and
Medicaid
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
.
Until 1966, when
Avedis Donabedian, MD published his "Evaluating the Quality of Medical Care", the study of health care quality was based on structure (e.g., licensing, staffing levels, accreditation). Donabedian demonstrated a new perspective on analyzing healthcare quality that was based on structure, process, and outcome.
The
National Academy of Sciences
The National Academy of Sciences (NAS) is a United States nonprofit, non-governmental organization. NAS is part of the National Academies of Sciences, Engineering, and Medicine, along with the National Academy of Engineering (NAE) and the Nati ...
established the
Institute of Medicine (IOM) in 1970. The IOM, a non-profit and independent scientific advisor, was created to improve health on a national scale. The
Accreditation Association for Ambulatory Health Care (AAAHC) formed in 1970 to improve healthcare quality for patients served by ambulatory health care organizations by setting standards for ambulatory healthcare accreditation, similar to JCAH. The
Agency for Healthcare Research and Quality (AHRQ) was created in 1989 in order to improve quality, safety, efficiency, and effectiveness of health care through research.
In 1990, the
National Committee for Quality Assurance (NCQA) was entrusted to offer accreditation programs for managed care organizations. The NCQA was established as an independent non-profit dedicated to improving health care quality through accreditation and performance measurement. In 1991,
Dr. Don Berwick's non-profit Institute for Healthcare Improvement (IHI) was founded. Rather than only focus on national health care quality improvement, IHI campaigned but nationally and worldwide. Directing the focus onto the patient as a consumer, the
National Patient Safety Foundation
The National Patient Safety Foundation (NPSF) was an independent not-for-profit organization created in 1997 to advance the safety of health care workers and patients, and disseminate strategies to prevent harm. In May 2017, the Institute for He ...
was established in 1996. In 1998, by presidential directive, the Quality Interagency Coordination Task Force (QuIC) was created to increase coordination of federal agencies that work toward improving quality care.
When the IOM published ''
To Err is Human'' in 1999, revealing high medical error mortality rates, the QuIC published a report that inventoried regulatory and legislative initiatives that sought to improve issues surrounding medical error. Also in 1999, the
National Quality Forum was founded. The private, non-profit forum aims to standardize health care delivery and measurements of quality. In response to the patient safety concerns discussed in ''To Err is Human'', the United States enacted the
Patient Safety and Quality Improvement Act
The Patient Safety and Quality Improvement Act of 2005 (PSQIA): , 42 U.S.C.&nbsch. 6A subch. VII part C established a system of patient safety organization
A Patient Safety Organization (PSO) is a group, institution, or association that imp ...
in 2005.
More recently, the focus of quality improvement has been emerging
health information technology
Health information technology (HIT) is health technology, particularly information technology, applied to health and health care. It supports health information management across computerized systems and the secure exchange of health informatio ...
(e.g.,
electronic health record
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared throu ...
s and
patient-centered care
Patient participation is a trend that arose in answer to medical paternalism. Informed consent is a process where patients make decisions informed by the advice of medical professionals.
In recent years, the term "patient participation" has been ...
. As a result, the formation of
Patient-Centered Medical Homes (PCMH) began to gain popularity in 2007. Under PCMH, care among personal primary care physicians and specialists increased coordination and integration of care for the patient. Furthermore, technology was used to maintain personal health information and enhance quality and
safety
Safety is the state of being "safe", the condition of being protected from harm or other danger. Safety can also refer to risk management, the control of recognized hazards in order to achieve an acceptable level of risk.
Meanings
There are ...
. Since 2007, various studies have demonstrated the wide array of benefits of PCMHs in healthcare quality improvement.
Organizations which determine quality
Organizations which work to set standards and measures for health care quality include
Government health systems; private health systems, accreditation programs such as those for
hospital accreditation,
health associations, or those who wish to establish
international healthcare accreditation
Due to the near-universal desire for safe and good quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process. Healthcar ...
;
philanthropic foundations
A foundation (also a charitable foundation) is a category of nonprofit organization or charitable trust that typically provides funding and support for other charitable organizations through grants, but may also engage directly in charitable act ...
; and health research institutions.
These organizations seek to define the concept of quality in healthcare, measure that quality, and then encourage the regular measurement of quality so as to provide evidence that health interventions are effective.
In the United States
Multiple organizations have established measures to define quality since providers, patients and payers have different views and expectations of quality. This complex situation creates a challenge because most often the measures of quality are not comparable across organizations and there are issues of transferability and merging across systems.
Consequently, while measuring health care quality for these reasons, high quality longitudinal provides a substantive framework from which health services researchers can work.
The
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
(CMS) designs quality evaluations, collects quality, and manages funding for the central government
Medicare and
Medicaid
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
programs.
In 2001, CMS started multiple quality initiatives including, but not limited to: the Home Health Quality Initiative, the Hospital Value-based Purchasing Program, the Hospice Quality Reporting Program, the Inpatient Rehabilitation Facilities Quality Reporting, and the Long-Term Care Hospitals Quality Reporting. CMS established initiatives to measure and improve the quality of care for Medicaid and CHIP beneficiaries for services provided under the umbrella of Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT), including maternal and infant health, home and community-based services, preventative care,
health disparities
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...
, patient safety, external quality review, and improving care transitions.
For broader quality control, CMS also created Hospital Compare, which is a large public reporting program that measures and also reports processes of care and outcomes for various health care interventions including heart failure, pneumonia, and acute myocardial infarction.
The
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered i ...
(AHRQ) is a central government organization which collects public reports of health quality evaluation to increase the safety and quality of health care. AHRQ works together with the United States Department of Health and Human Services to make ensure that evidence is understood and used by the medical communities to elevate the quality of care. To fulfill its mission, AHRQ contracts with several subsites.
CMS and AHRQ have collectively established the
Hospital Consumer Assessment of Healthcare Providers and Systems (
CAHPS) survey. The CAHPS survey collects uniform measures of patients' perspectives on various aspects of the care they receive in inpatient settings. The results are published on the Hospital Compare website, which may be used by health care organizations and researchers to improve the quality of their services. Purchasers, consumers, and researchers may also use the data to make informed business choices.
The Joint Commission Accreditation for Healthcare Organization (JCAHO) is a nonprofit organization that assesses quality at multiple levels by inspecting health care facilities for adherence to clinical guidelines, compliance with rules and regulations for medical staff skills and qualifications, review of medical records to evaluate care processes and search for medical errors, and inspects buildings for safety code violations. JCAHO also provides feedback and opportunities for improvement, while simultaneously issuing citations for closures of facilities deemed noncompliant with set measures of quality standards. howdy
In the United Kingdom
In the UK, healthcare is publicly funded and delivered through the National Health Service (NHS) and quality is overseen by a number of different bodies.
Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
, a non-departmental public body sponsored by the
Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
, is the sector regulator for health services in England. It works closely with the
Care Quality Commission
The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England.
I ...
(CQC) a government-funded independent body responsible for overseeing the quality and safety of health and social care services in England, including hospitals, care homes, dental and GPs and other care services. The
National Institute for Health and Care Research
The National Institute for Health and Care Research (NIHR) is the British government’s major funder of clinical, public health, social care and translational research. With a budget of over £1.2 billion in 2020–21, its mission is to "impr ...
(NIHR) has a number of infrastructure programmes supporting quality in healthcare, including the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs).
Medical professions in the UK have their own membership and regulatory associations. These include the
General Medical Council
The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by c ...
(GMC), the
Nursing and Midwifery Council
The Nursing and Midwifery Council (NMC) is the regulator for nursing and midwifery professions in the UK. The NMC maintains a register of all nurses, midwives and specialist community public health nurses and nursing associates eligible to prac ...
, the
General Dental Council
The General Dental Council (GDC) is an organisation which regulates dental professionals in the United Kingdom. It keeps an up-to-date register of all qualified dentists and other dental care professionals such as: dental hygienists, dental ther ...
and the
Health and Care Professions Council
The Health and Care Professions Council (HCPC, formerly the Health Professions Council, HPC) is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose i ...
. Other healthcare quality organisations include the Healthcare Quality Improvement Partnership (HQIP), a charity and limited company established by the Academy of Medical Royal Colleges, the Royal College of Nursing, National Voices; and Healthwatch, a statutory national body that works with groups across the country to ensure that patients' views are at the heart of decisions about the healthcare system.
A number of health think tanks, including the
King's Fund
The King's Fund is an independent think tank, which is involved with work relating to the health system in England. It organises conferences and other events.
Since 1997, they have jointly funded a yearly award system with GlaxoSmithKline. Th ...
, the
Nuffield Trust
The Nuffield Trust, formerly the Nuffield Provincial Hospitals Trust, is a charitable trust with the mission of improving health care in the UK through evidence and analysis.
The Nuffield Trust is registered with the Charity Commission as char ...
and the
Health Foundation
The Health Foundation is an independent charity for health care for people in the UK.
The organisation’s aim is a healthier population, supported by high quality health care that can be equitably accessed. Its programs include making grants to ...
offer analysis, resources and commentary around healthcare quality. In 2013, the Nuffield Trust and the Health Foundation launched QualityWatch, an independent research programme tracking how healthcare quality in England is changing in response to rising remand and limited funding.
In India
Healthcare quality efforts in India are beginning to gain strength. Some organizations involved in this work include the National Accreditation Board for Hospital & Healthcare providers (NABH), Patient Safety Alliance, ICHA and National Health Systems Resource Center (NHSRC). The All India Institute of Medical Sciences is also leading some of the healthcare quality work in India and in the SEARO region.
See also
* ''
Evaluation & the Health Professions'' (journal)
*
References
Further reading
*
*
*
{{Health care quality