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"a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria.
The Donabedian model is a common framework for assessing health care quality and identifies three domains in which health care quality can be assessed: structure, process, and outcomes. [14] All three domains are tightly linked and build on each other. Improvements in structure and process are often observed in outcomes.
The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. [1] According to the model, information about quality of care can be drawn from three categories: "structure", "process", and "outcomes". [2]
Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [1] [2] A discipline-specific process may be referenced accordingly (e.g., physician peer review, nursing peer review).
In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4] Communication and Care Coordination; Community/Population Health; Effective Clinical Care; Efficiency and Cost Reduction; Patient Safety
Quality Improvement can be distinguished from Quality Control in that Quality Improvement is the purposeful change of a process to improve the reliability of achieving an outcome. Quality Control is the ongoing effort to maintain the integrity of a process to maintain the reliability of achieving an outcome.
Traditional state-based legal protections for such health care quality improvement activities, collectively known as peer review protections, are limited in scope: They do not exist in all States; typically they only apply to peer review in hospitals and do not cover other health care settings, and seldom enable health care systems to pool data ...
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.