Health care quality assurance

Health care quality assurance is "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps."

Health care quality assurance addresses topics such as reduction in medical error and cross infections.

Creating quality measures
Creating quality measures from clinical practice guidelines can be problematic.

Measuring quality
Chart abstraction may underestimate quality.

Improving quality
More experience, as measured by volume of care, is associated with better quality of care.

Process control charts can be used to identify specific problems that need improvement. Examples are assessing methods to obtain blood cultures, the impact of screening for methicillin resistant Staphylococcus aureus and comparing mortality in surgical units.

Audit and feedback
Audit and feedback has been systematically reviewed by the Cochrane Collaboration who concluded its "effects are generally small to moderate."

More recently, a factorial, cluster randomized controlled trial of audit and feedback concluded "enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies ." The feedback in this trial was enhanced with an educational message.

Public reporting of quality measures
A systematic review found that "publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain". However, a comparative study found concerns with the quality of data that is publically available.

Research on quality improvement
Guidelines exist for the reporting of studies on quality improvement (http://www.squire-statement.org/).