[Assessment of the quality of health care: heart surgery].
In the process of health planning and of the evaluation of health care, there is growing interest in assessing the quality of medical care. Traditionally, quality indexes are divided into three groups: structure, process and outcome. The first two indexes can be measured more easily and quickly, but outcome indexes are more appropriate care indicators for both health planners and patients. The introduction of quality assessment means that physicians work in order to achieve the required standards even if it does not increase the real quality of care, that data are systematically biased in order to increase the quality score and, lastly, that physicians do not rely on case-mix statistical adjustment of results. All these problems have already been evaluated by the Health Department of New York State. Since 1989, outcome data of open-heart surgery have been monitored in all cardiac surgery centers in the state. It is still open to debate whether the decreased mortality in New York State is due to the quality assessment program, to the migration of sicker patients to nearby states, or to the refusal of heart surgeons to operate on high-risk patients. In Italy as well, new rules have been introduced into health legislation in order to assess the quality of health care. Even if methodological and legislative instruments to assess quality of care are still not completely reliable in terms of assessing the quality of care with simple and effective methods, this does not exclude the need to proceed in assessing the quality of health care.
Bobbio
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Divisione Universitaria di Cardiologia, Ospedale Molinette, Fondazione Arturo Pinna Pintor, Torino.
Pintor
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D006348:Cardiac Surgical Procedures / Q000592:standards*; D006801:Humans; D007558:Italy; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence; D011787:Quality of Health Care / Q000331:legislation & jurisprudence / Q000592:standards