Evaluating quality in clinical care

Healthcare quality is under increasing attention and focus. Being able to effectively analyse quality is vital to driving improvement in outcomes. This article aims to discuss the historical background and development of healthcare quality assessment and discuss some common definitions and frameworks used today. We discuss the Royal College of Surgeons (RCS) recent guidance and the use of the Donabedian model - of structures, outcomes and processes - as a helpful way to assess quality. Using examples from national audits such as the Lung Cancer Clinical Outcomes Publication we will show how there is an increasing shift away from solely reporting mortality towards new outcomes, including patient reported outcome measures (PROMS) such as thirst and pain, in current practice. We also discuss how results from different units can be published and compared, for example on an individual or unit basis, which leads on to important topics related to healthcare quality such as case mix adjustment and outlier management.