The Institute of Medicine defines quality of care as \u201cthe degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.\u201d[649]<\/a><\/sup> In addition to whether care for a particular condition achieves desired health outcomes, other considerations in gauging quality of care include accessibility, the quality of the patient experience when receiving care, and how the processes of care delivery are structured in a manner to constrain health care costs.[650]<\/a>–[652]<\/a><\/sup> Quality assurance is a process whereby a health care organization can ensure that the care it delivers for a particular illness meets accepted quality standards.[640]<\/a>,[649]<\/a>,[650]<\/a><\/sup> Inherent characteristics of this process include:<\/p>\n\n\n\n A review of the large body of literature regarding quality assurance and safety is beyond the scope of this section. Instead, we address issues specific to quality care in the HF population with additional details in sections 9.2-9.7<\/em> of the Supplementary Material, and in Table 44.<\/p>\n\n\n Recommendation<\/p> 176. We recommend that health care systems should provide for quality assurance in the process as well as content of care provision (Strong Recommendation; High-Quality Evidence).<\/p>\n 177. We recommend that quality assurance programs should include the following elements to allow for assessment of patient, provider, and health care institutional outcomes (Strong Recommendation; Moderate-Quality Evidence):<\/p>\n i. Measurement of evidence-based key performance indicators to assess system performance and outcomes.<\/p>\n ii. Robust measurement of important clinical and system of care outcomes.<\/p>\n iii. Intervention supports such as clinical tools to facilitate best practices.<\/p>\n iv. Performance feedback and education to HF care professionals and administrators.<\/p>\n <\/div>\n <\/div>\n<\/div>\n\n\n Practical Tip<\/p> Selection of performance indicators with outcome data from randomized clinical trials, such as those listed in the CCS Quality Indicators E- Library-Heart Failure (https:\/\/ccs.ca\/images\/Health_Policy\/Quality-Project\/Indicator_ HF_V2.pdf), is preferred.<\/p>\n <\/p>\n Institutional quality improvement strategies that include the following features have been shown to improve outcomes:<\/p>\n <\/p>\n It is unclear if any single intervention is superior to another. Use of multiple simultaneous interventions provides a larger effect size.<\/p>\n <\/p>\n Examples of interventions with the highest quality of evidence for outcome improvement at a system level include:<\/p>\n <\/p>\n <\/p>\n <\/p>\n Examples of isolated interventions with limited evidence for improved process measure outcome improvement at a system level include:<\/p>\n <\/p>\n Broader regional, provincial, and national frameworks are required to promote and facilitate quality assurance initiatives at all levels of HF care.<\/p>\n <\/p>\n <\/p>\n<\/div>\n\n\n <\/p>\n 649. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press (US), 2001.<\/p>\n <\/p>\n 650. Fishman PA, Hornbrook MC, Meenan RT, Goodman MJ. Opportunities and challenges for measuring cost, quality, and clinical effectiveness in health care. Med Care Res Rev 2004;61:124S-43S.<\/p>\n <\/p>\n 651. Rubin HR, Pronovost P, Diette GB. The advantages and disadvantages of process-based measures of health care quality. Int J Qual Health Care 2001;13:469-74.<\/p>\n <\/p>\n 652. Mant J. Process versus outcome indicators in the assessment of quality of health care. Int J Qual Health Care 2001;13:475-80.<\/p>\n <\/p>\n 653. Campbell SM, Braspenning J, Hutchinson A, Marshall MN. Research methods used in developing and applying quality indicators in primary care. BMJ 2003;326:816-9.<\/p>\n <\/p>\n 654. Donabedian A. Quality assessment and assurance: unity of purpose, diversity of means. Inquiry 1988;25:173-92.<\/p>\n <\/p>\n<\/p><\/div>\n","protected":false},"featured_media":0,"parent":127416,"menu_order":11,"template":"guideline-chapter.php","topic":[],"resource_type":[],"acf":[],"yoast_head":"\n\n
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References<\/h2>