Defining quality of care

This paper defines quality of health care. We suggest that there are two pr incipal dimensions of quality of care for individual patients; access and e ffectiveness. In essence, do users get the care they need, and is the care effective when they get it? Within effectiveness, we define two key compone nts - effectiveness of clinical care and effectiveness of inter-personal ca re. These elements are discussed in terms of the structure of the health ca re system, processes of care, and outcomes resulting from care. The framewo rk relates quality of care to individual patients and we suggest that quali ty of care is a concept that is at its most meaningful when applied to the individual user of health care. However, care for individuals must placed i n the context of providing health care for populations which introduces add itional notions of equity and efficiency. We show how this framework can be of practical value by applying the concepts to a set of quality indicators contained within the UK National Performance Assessment Framework and to a set of widely used indicators in the US (HEDIS). In so doing we emphasise the differences between US and UK measures of quality. Using a conceptual f ramework to describe the totality of quality of care shows which aspects of care any set of quality indicators actually includes and measures and, and which are not included. (C) 2000 Elsevier Science Ltd. All rights reserved .