Quality in paediatric cardiology

Abstract

The principal elements of measures of quality in medicine include structure, process and outcome. Structure incorporates the physical work environment as well as the organisation of the work unit and institution. Process describes the methods of care delivery and includes clinical protocols and pathways, communication strategies and clinical competency assessment. Outcome is what happens to the patient. This includes not only mortality and complications, but also the success or failure of the treatment strategy and patient satisfaction. Caregivers often concentrate on measures of process because they are more directly under the control of the provider. Outcomes have many determinants over which the provider may have little influence, but patients and payers, on the other hand, are usually more interested in outcomes. Measures of mortality, complications and success of treatment should include medical as well as surgical treatment as concentrating on surgical measures fails to afford opportunities to improve overall results. Long-term outcomes, while extremely important, are difficult to measure and relate to treatment strategies. Consequently, this remains in the realm of healthcare quality research. While much remains to be done in quality assessment and improvement, a more effective delivery of current therapies is likely to improve outcomes more than the discovery of new therapies.