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The many ways to measure and record quality of care

Data sources for measuring quality of care

One of the challenges of measuring quality care is data availability, as we mentioned earlier this week.

Recently, the Health Data Collaborative at WHO reported that health workers spend 33% of their time in collecting and reporting data. If we are serious about health system improvement ,we need to be aware of the additional burden that data collection and analysis places on our health workforce. Akachi and Kruk in a 2017 article provide a really helpful summary of where and how we can measure quality across the structure, process and outcomes of the health system. Their framework is reproduced here. Notice that structure and outcome measures tend to be easier to measure within usual reporting systems, but measuring the process is much more difficult, and rarely done routinely, yet this is where our understanding of quality will be the richest.

Domains of quality-of-care measurement and data sources

Image source: based on fig. 2 in Akachi, Y. and Kruk, M.E., 2017. Quality of care: measuring a neglected driver of improved health. Bulletin of the World Health Organization, 95(6), p.465

The six policy recommendations from the authors are:

  1. Improve and institutionalise civil registration and vital statistics systems
  2. Reform facility surveys and strengthen routine information systems
  3. Create new quality of care measures for low-resource contexts
  4. Get the patient perspective on quality
  5. Invest in national measurement of quality of care data
  6. Analyse and present quality of care evidence in ways that produce policy impacts

These six policy areas address structure, process and outcomes, and provide a helpful framework to look at a country’s quality improvement plan.

Can you identify policy responses for each of these six recommendations in your own setting?

Akachi, Y & Kruk, ME, 2017, ‘Quality of care: measuring a neglected driver of improved health’, Bulletin of the World Health Organization, vol. 95, no. 6, p.465.
Madaj, B, Smith, H, Mathai, M, Roos, N & van den Broek, N, 2017, ‘Developing global indicators for quality of maternal and newborn care: a feasibility assessment’, Bulletin of the World Health Organization, vol. 95, no. 6, p.445.

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