In 1966 Donabedian published his seminal work that described three distinct aspects of quality in healthcare: (1) outcome; (2) process (healthcare technologies); and (3) structure (resources for delivery of care).
Clinical outcomes
In 1966 Donabedian
published his seminal work that described three distinct aspects of quality in
healthcare: (1) outcome; (2) process (healthcare technologies); and (3)
structure (resources for delivery of care). He concluded that: ‘Outcomes, by
and large, remain the ultimate validation of the effectiveness and quality of
medical care’. Standardised mortality rates have become a crude outcome measure
but are used to describe a healthcare organisation’s overall success. Other
recent outcome measures include meticillinresistant Staphylococcus aureus
bacteraemia rates and Clostridium difficile infections which have a direct
relevance to antimicrobial stewardship (AMS). More recently, patient-reported
outcome measures (PROMs) have been advocated as a relevant outcome measure to
describe patients’ satisfaction in their healthcare provider. Four elective
procedures were initially proposed for PROMS data evaluation – hernia repair,
hip and knee replacement and varicose veins – but a growing range of long-term
conditions including diabetes, asthma, chronic obstructive pulmonary disease,
epilepsy, heart failure and stroke are being added. These long-term conditions
have medication effectiveness at their core and will offer considerable
potential for clinical pharmacy involvement. At the time of writing, in
England, consultation has begun on how an outcomes-based approach can be built
into the routine running of the NHS. It will be interesting to see how
medicines use and the role of clinical pharmacists can contribute to this
agenda.
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