Quality and Safety in Health Care

The U.S. health care system has serious quality problems. The National Academy of Medicine (formerly the Institute of Medicine) has characterized them in three categories. One is underuse, in which individuals fail to receive services that save lives or prevent disability. Another is misuse, where individuals are injured when avoidable complications of health care are not prevented. And the last is overuse, in which individuals are exposed to the risks of health services from which they cannot benefit. Research has also noted significant geographic variations in the quality of care. For example, hospital discharge rates vary across regions, as does adherence to recommended screenings for people with diabetes. Low-quality care is costly—in both financial and human terms—and it lowers consumer confidence in the health care industry.

The academy has reported that the delivery of care is often overly complex and requires too many steps for the patient. These extra steps can waste time and money and risk patient health and safety.

The academy has recommended a national vision for improving the quality of care and fostering innovation within the health care system built upon six quality domains. Health care should be safe, effective, patient-centered, timely, efficient, and equitable. These elements were subsequently incorporated into the National Quality Strategy’s six priorities.