Quality informatics

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In order to address the "Quality of Health Care", attempts have been made to first define the phrase "quality health care". The father of health quality assurance, Avedis Donabedian said that high quality health care consisted of "that kind of care which is expected to maximize an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts." (1)

The American Medical Association described high quality health care as that "which consistently contributes to improvement or maintenance of the quality and/or duration of life." (2)

Lohr and her committee were tasked by the IOM to define quality health care and their definition was "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." (3)

The fact that multiple definitions of health care quality exist is an indication that this is a very complex subject to try to define in a few phrases. Donabedian (4) further described attributes of quality health care, which he called the "Seven Pillars of Quality":

1. Efficacy: the ability of care, at its best, to improve health;

2. Effectiveness: the degree to which attainable health improvements are realized;

3. Efficiency: the ability to obtain the greatest health improvement at the lowest cost;

4. Optimality: the most advantageous balancing of costs and benefits;

5. Acceptability: conformity to patient preferences regarding accessibility, the patient-practitioner relation, the amenities, the effects of care, and the cost of care;

6. Legitimacy: conformity to social preferences concerning all of the above; and

7. Equity: fairness in the distribution of care and its effects on health.

In a similar fashion, Maxwell (5) defined the six dimensions of quality health care:

1. Access to services

2. Relevance to need (for the whole community)

3. Effectiveness (for individual patients)

4. Equity (fairness)

5. Social Acceptability

6. Efficiency and Economy


1. Donabedian A. Explorations in quality assessment and monitoring. Vol. 1. The definition of quality and approaches to its assessment. Ann Arbor, Mich.: Health Administration Press, 1980.

2. American Medical Association, Council of Medical Service. Quality of care. JAMA 1986;256:1032-1034.

3. Lohr KN, ed. Medicare: a strategy for quality assurance. Washington, D.C.: National Academy Press, 1990.

4. Donabedian, A. (1990). "The seven pillars of quality." Archives of Pathology & Laboratory Medicine 114(11): 1115.

5. Maxwell, R. (1984). "Quality assessment in health." British Medical Journal 288(6428): 1470-1.

6. Donabedian, A. (1969). "Quality of care: problems of measurement. II. Some issues in evaluating the quality of nursing care." American Journal of Public Health 59(10): 1833.