Defining of quality

Social Science & Medicine 51 (2000) 1611±1625

www.elsevier.com/locate/socscimed

De®ning quality of care
S.M. Campbell*, M.O. Roland, S.A. Buetow
National Primary Care Research and Development Centre, The University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK

Abstract This paper de®nes quality of health care. We suggest that there are two principal dimensions of quality of care for individual patients; access and e€ectiveness. In essence, do users get the care they need, and is the care e€ective when they get it? Within e€ectiveness, we de®ne two key components Ð e€ectiveness of clinical care and e€ectiveness of inter-personal care. These elements are discussed in terms of the structure of the health care system, processes of care, and outcomes resulting from care. The framework relates quality of care to individual patients and we suggest that quality 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 in the context of providing health care for populations which introduces additional notions of equity and eciency. 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 di€erences between US and UK measures of quality. Using a conceptual framework 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. 7 2000 Elsevier Science Ltd. All rights reserved.
Keywords: Quality; Care; HEDIS; NHS

Introduction Growing demand for health care, rising costs, constrained resources, and evidence of variations in clinical practice have increased interest in measuring and improving the quality of health care in many countries of the