The Quality Assurance Project (QAP) was initiated in 1990 to develop and implement sustainable approaches for improving the quality of health care in less developed countries. QAP has two broad objectives: 1) to provide technical assistance in designing and implementing effective strategies for monitoring quality and correcting systemic deficiencies; and 2) to refine existing methods for ensuring optimal quality health care through an applied research program.
QAP helps LDC health managers to apply systematic methods for problem identification and resolution. Through the projectís research component, known as Methodology Refinement, QAP staff is developing, refining, and validating cost-effective measures for improving the quality of health care. The project team is working toward this goal by reviewing the current state-of-the-art in quality assurance and collaborating with host-country colleagues in conducting seminal studies on how to best achieve optimal quality of care. Priority research areas include cost-effective data collection methods, establishing and instituting standards for provider performance and support systems, methods of identifying and prioritizing operational problems, and simple problem-solving methods.
Selected QAP research activities will be featured in the Quality Assurance Methodology Refinement Series. This first report, Quality Assurance of Health Care in Developing Countries, describes QAPís approach to introducing quality assurance methods into LDC health care delivery systems. It discusses the feasibility of implementing quality improvement mechanisms, describes QAPís quality assurance process, and provides an overview of how to build a quality assurance program.
This paper defines quality of health care. We suggest that there are two principal dimensions of quality of care for individual patients; access and e€ectiveness. In essence, do users get the care they need, and is the care e€ective when they get it? Within e€ectiveness, we de®ne two key components Ð e€ectiveness of clinical care and e€ectiveness of inter-personal care. These elements are discussed in terms of the structure of the health care system, processes of care, and outcomes resulting from care. The framework relates quality of care to individual patients and we suggest that quality of care is a concept that is at its most meaningful when applied to the individual user of health care. However, care for individuals must placed in the context of providing health care for populations which introduces additional notions of equity and eciency. We show how this framework can be of practical value by applying the concepts to a set of quality indicators contained within the UK National Performance Assessment Framework and to a set of widely used indicators in the US (HEDIS). In so doing we emphasise the di€erences between US and UK measures of quality. Using a conceptual framework to describe the totality of quality of care shows which aspects of care any set of quality indicators actually includes and measures and, and which are not included. Elsevier Science Ltd. All rights reserved.
