Measures and Determinants Of Treatment Quality. A Literature Review Evaluating Health Care Quality Quality of health care – “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”---Institute of Medicine 77 Providing patients with appropriate services for the improvement of their condition is a key indicator of good quality care. The overuse, underuse, and misuse of treatments are three problems that may occur within the US health care system. Xxxxxxxxxx, one of the pioneers of health care quality research, states in his classic article that health care quality can be evaluated based on either the assessment of structure, outcomes, or process of health care 78. Structural quality assesses the characteristics of the medical environment or setting in which the health care takes place 78, 79 . Outcome quality assesses the health status of the patient following medical care 78, 79. Process quality assesses the health care procedures performed by the physician and whether “good” health care has been provided based on current professional knowledge 78, 79. The feasibility of studies investigating quality of care depends on the availability of data. These data must be “easily, sometimes routinely, measurable and reasonably valid” 78. There is also a need for the identification of disparities in quality of care and the assessment of explanations for these disparities. Appropriate evidence-based actions cannot be made to reduce and/or eliminate disparities in health care until we understand who is at risk for poor quality care and what determines this risk. Health care quality varies by community and patient race. The following discussion will define and discuss community and racial factors that may be associated with quality of health care. Residential Segregation Community characteristics have been associated with health and health care outcomes in many studies. However, few studies have assessed the role of racial segregation in health care disparities and none have evaluated the association between economic segregation and health care. Segregation is the physical separation of groups (racial or economic) in residential contexts. Racial segregation was historically enforced by law, backed by major economic institutions and housing policies, and encouraged by racism and racial discrimination 80, 81. Restrictive covenants limited housing options for blacks to least desirable residential areas ...
