[The objective assessment of the quality of hospital care: dream or reality?].
One of the hottest topics of the international journals is the question: what is the effect of the public indicator-based quality assessment on the quality of care and on the decision of stakeholders, and which criteria should be applied for development of public quality assessment system. According to the international literature the paper discusses 6 topics: (1) the ability of indicators to distinguish providers from the point of view of quality; (2) the appropriateness of outcome indicators to assess providers; (3) the ability of league tables to rank providers; (4) the people's behaviour during choosing providers; (5) the impact of indicator-based public report; (6) recommendations for developing quality assessment system. Based on the literature review, the ability of indicators in distinguishing providers from the point of view of quality is doubtful primarily because of risk-adjustment problems. Other reasons are: the outcomes of care do not definitely refer to the quality of care process; the rankings of providers (league tables) based on more indicators are not reliable; people take into account mainly distance and the opinions of acquaintance when they choose providers; as a result of public reports the overall quality of care is declining. The publication of the results of measurement to assess providers has to be considered as a tool. For the purpose of helping people in choosing providers, the publication of patient satisfaction survey designed according to their preferences could achieve the desired effect. The quality improvement aims are definitely helped by the direct feedback to providers about the indicator values. Furthermore, much finer picture can be made if the standardized audits of care and organisational processes are inserted into external assessment procedures.
Belicza
Eva
E
Semmelweis Egyetem, Egészségügyi Menedzserképzo Központ, Budapest, Pf. 610. 1528. belicza@emk.sote.hu
Takács
Erika
E
D005069:Evaluation Studies as Topic; D006761:Hospitals / Q000592:standards*; D006801:Humans; D006814:Hungary; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D017749:Total Quality Management