Evaluating health care.

TLDR: It is suggested that analysis in depth at two points of this paradigm, the entry to care and the outcomes of care, are the most likely to reveal the basis of failures.

Abstract: Evaluation of health care is equated with the intent to continuously improve rather than to control its quality. Quality is seen as being affected by and therefore embracing 1) patient's health status and attitudes on entry to care, 2) suitability of the delivery machinery (structure), 3) application of care (process), and 4) outcomes of application to care. It is suggested that analysis in depth at two points of this paradigm, the entry to care and the outcomes of care, are the most likely to reveal the basis of failures. These may largely reside with the patient, the health care delivery structure, or the inability of the patient and care deliverer to perform together appropriately. These suggest the kind of interventions most likely to provide good results in the future. Such interventions or changes are very likely to call for significant changes in many social institutions, including that of the health care delivery machinery. Focusing on process is seen as contributing to professional education but less likely to result in meaningful changes because it works on the assumption that what the professional in a given illness cycle offers is the main factor in achieving better quality care.