QUALITY ASSESSMENT is defined by the ADA as the measure of the quality of care provided in a particular setting.

QUALITY ASSURANCE is the assessment or measurement of the quality of care and the implementation of any necessary changes to either maintain or improve the quality of care rendered.

The differences in these definitions are important; quality assessment is limited to the appraisal of whether or not standards of quality have been met, whereas quality assurance includes the added dimension of corrective action to improve the future situation.

One frequently used approach to quality assessment and assurance builds on the concepts of structure, process, and outcome, as described by Donabedian.*

This model is based on the idea that while the outcome of treatment is of primary importance, a desirable outcome is more likely if the structural arrangements, such as well-designed treatment facilities, proper equipment, and appropriately and properly trained staff, meet adequate standards. A good outcome is also more likely if the processes used, such as diagnostic methods, treatment planning, record keeping, and the treatment procedures themselves follow recognized protocols.

Other dimensions of quality that are frequently mentioned, in addition to the technical quality of restorative procedures, are appropriateness of care, access to care, costs of care, and patient satisfaction. * Donabedian A. Explorations in quality assessment and monitoring. Vol 1. The definition of quality and approaches to its assessment Ann Arbor, MI: Health Administration Press, 1980.

STRUCTUREPROCESSOUTCOME
Facilities
Setting Physical structures
Layout
Amenities
Access

Equipment
Operatories
Instruments
Supplies
Sterilization

Personnel
Appropriate types
Training Licensure
Certification<
CDE

Administration Procedures
Record systems

Protocols
Management
Practice
Personnel
Patient

Records
Content
Completeness
Availability
Legibility

Diagnosis
Appropriateness Documentation
Thoroughness

Treatment plan
Written

Sequencing
Patient satisfaction

Oral health status
Oral hygiene
Tooth loss
Periodontitis
Caries

Completion
of treatment
Timely
Appropriate

Recall pattern
Frequency

Needs at recall

Some Further Quality References

O`Mahony, B (1999)Irish Health Care Web Sites: A Review. Irish Medical Journal: 92(4):334-7

Coulter, A. (1998). Evidence based patient information. BMJ: 317: 225-226 [Full text]

Silberg M, Lundberg GD, Musacchio RA. (1997). Assessing, controlling, and assuring the quality of medical information on the internet. Caveat lector et viewor – let the reader and viewer beware. JAMA; 277: 1244-1245 [Medline]

McNab A, Anagnostelis B, Cooke A. (1997). Never mind the quality, check the badge-width! Ariadne 1997 May 18; 9. http://www.ariadne.ac.uk/issue9/quality-ratings.

Ambre J, Guard R, Perveiler FM, Renner J, Rippen H. White paper: criteria for assessing the quality of health information on the internet (working draft, edited 14 Oct 1997). http://www.mitretek.org/hiti/showcase/documents/criteria.html[6 Apr 1998].

Morris TA, Guard RJ, Marine SA, Schick L, Haag D, Tsipis G, et al. (1997). Approaching equity in consumer health information delivery: NetWellness. J Am Med Inf Assoc; 4: 6-13 [Medline]

Check out the Irish Society for Quality in Healthcare at ISQH
Download selection of articles collected as 473KB Acrobat PDF document Quality on the NET
Download 99KB PDF document Public Sector Site Guidelines

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