Measuring quality: From the system to the provider

D. B. Evans, T. Tan-Torres Edejer, J. Lauer, Julio Frenk, C. J L Murray

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

The literature on quality has often focused on process indicators. In this paper we outline a framework for describing and measuring the quality of health systems in terms of a set of desirable outcomes. We illustrate how it can be measured using data collected from a recent evaluation of health system performance conducted by the World Health Organization (WHO). We then explore the extent to which this framework can be used to measure quality for all components of the system; for example, regions, districts, hospitals, and providers. There are advantages and disadvantages to defining quality in terms of outcomes rather than process indicators. The advantage is that it focuses the attention of policy makers on whether systems are achieving the desired goals. In fact, without the ability to measure outcomes it is not possible to be sure that process changes actually improve attainment of socially desired goals. The disadvantage is that measuring outcomes at all levels of the system poses some problems particularly related to the sample sizes necessary to measure outcomes. WHO is exploring this, initially in relation to hospitals. The paper discusses two major challenges. The first is the question of attribution, deciding what part of the outcome is due to the component of the system under discussion. The second is the question of timing, including all the effects of current health actions now and in the future.

Original languageEnglish (US)
Pages (from-to)439-446
Number of pages8
JournalInternational Journal for Quality in Health Care
Volume13
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Health
Outcome Assessment (Health Care)
District Hospitals
Administrative Personnel
WHO
Sample Size
health
attribution
district
ability
evaluation
performance

Keywords

  • Health system performance
  • Measurement
  • Quality

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Public Health, Environmental and Occupational Health

Cite this

Measuring quality : From the system to the provider. / Evans, D. B.; Tan-Torres Edejer, T.; Lauer, J.; Frenk, Julio; Murray, C. J L.

In: International Journal for Quality in Health Care, Vol. 13, No. 6, 2001, p. 439-446.

Research output: Contribution to journalArticle

Evans, D. B. ; Tan-Torres Edejer, T. ; Lauer, J. ; Frenk, Julio ; Murray, C. J L. / Measuring quality : From the system to the provider. In: International Journal for Quality in Health Care. 2001 ; Vol. 13, No. 6. pp. 439-446.
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