The demand for the best medical services is in constant increase in many parts of the world because of changes in global demography. The increase in life expectancy and greater disease complexity make the optimization of resources, improving and maintaining healthcare services, and developing procedures and organization necessary. Otherwise, the many measures that have been meant to introduce legal and administrative constraints continually have acted in the complication of consolidated excellent medical services. Therefore, the identification of these critical indicators is essential in finding the strengths and weaknesses of healthcare services. The collection of data from different sources, their homogenous classification, maintenance, acquisition, analysis and presentation are equally significant. These measures have proven to be important in developing scientific tools and methods for swift statistics and predictive valuation. Notably, the splitting of health services through fundamental capacity, mission, procedures, and results lead to the advantage of quality measurement and macro interacting context.
Background
South Africa is wholly estranged in a dual burden of chronic non-communicable and infectious disease. The response of initiating Integrated Chronic Disease Management (ICDM) model in the primary healthcare has helped in the facilitation of 2011 HIV/ART program, which has played key roles in improving health care quality (Ameh, Gómez-Olivé, Kahn, Tollman, & Klipstein-Grobusch, 2017). Otherwise, very little is recognized about the eminence of care that comes from the ICDM model. Subsequently, the aims of the study are to assess the quality of care in ICDM model and assess operational managers and patients’ satisfaction with ICDM service’s dimensions. These objectives could only be achieved with the involvement of Avedis Donabedian’s theory that connects structures, processes, and outcomes as critical measures of quality of healthcare. According to Ameh, Gómez-Olivé, Kahn, Tollman, and Klipstein-Grobusch (2017), structures represent resources while processes and outcomes are other definitions of medical activities and anticipated results of healthcare, respectively.
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Alternatives
It is tough to define the concept of “Quality Medical Care” because of its context. The consideration of goals and values in the health care coordination in the ICDM model is essential in finding the quality that anyone would wish to meet. Pecoraro, Luzi, Cesarelli, and Clemente (2015) argues that there is no single unitary concept that can define patient care, just like morale, which means that there is no measure for the eminence of patient care. Subsequently, Donabedian Framework takes advantage of measuring quality on every dimension of the healthcare system.
Quality health care provision and application need the homogenous use of elements that are related to the concept of health. For instance, processes and outcomes of research data should be merged with hospital information system in the provision of facts that can give a clear picture of employed staff and available facilities (Allen-Duck, Robinson, & Stewart, 2017). Therefore, the alternatives are based on analysis of data and identification of consistency in the provided data, selection of suitable data, finding a sound method through Donabedian method, and verifying the reliability of case study through the definition of its proposed approach.
Proposed Solutions
Avedis Donabedian model has seven factions of measuring the eminence of health care. According to Ameh, Gómez-Olivé, Kahn, Tollman, and Klipstein-Grobusch (2017), these features are “Efficacy, Effectiveness, Efficiency, Equity, Optimality, Acceptability and Legitimacy.” Measuring efficacy is very hard, and its description of care as the optimal condition is unlimited. Otherwise, effectiveness, efficiency, and equity are all measurable elements that describe intervention’s outcomes, cost reduction, health care distribution fairness, respectively. Also, optimality is more of balancing benefits and cost of healthcare which can be measured in Avedis Donabedian. Subsequently, Ameh, Gómez-Olivé, Kahn, Tollman, and Klipstein-Grobusch (2017) argues that acceptability and legitimacy expound on healthcare and social acceptability, which positively impacts the mannerism of healthcare delivery. Therefore, these measurable elements of health care service delivery are directed by the context in which the excellence of health care is evaluated in a triad of structure, process and outcome (SPO) framework.
Ameh, Gómez-Olivé, Kahn, Tollman, and Klipstein-Grobusch (2017) postulate that there are connections between SPO frameworks grounded in the notion that upright outcome is a product of a good process, which is a product of good structure. Subsequently, the SPO model represents three chain boxes that are interconnected and can be used to conclude the quality of health being offered or received. Donabedian structure ensures the availability of medicine and staff training, which are distinguished by two critical outcomes of technicality and interpersonal. The technical issues are functional and physical aspects that are marred with a reduction in disease and lack of complications, disability, and even death (Coombs, Burston, & Liu, 2017). Interpersonal outcomes are matters that deal with patient’s satisfaction and influence of the received care on the quality of life of the patient. Donabedian concept helps analyze the quality of health care in a move to make healthcare service delivery more interactive, successful, and team-based.
Avedis Donabedian model evaluates the quality of health care in ICDM model not only because of pf its dominance, but also the quality of medical care evaluation. Subsequently, the SPO system used in South Africa to implement the ICDM model collects critical information from quality coordinators and department managers. According to Ameh, Gómez-Olivé, Kahn, Tollman, and Klipstein-Grobusch (2017), Avedis Donabedian model uses “a systematic review to find the effectiveness of integrating primary health services” by focusing on the provider of medical care instead of the receiver. Generally, a receiver’s satisfaction is very significant in coming up with the ICDM models for quality health care. Assessing operational managers’ and patients’ satisfaction using ICDM and assessing the quality of care through the same ICDM ideal is better achieved by using Donabedian’s SPO framework.
Recommendations
The South African public health care model uses a professional nurse as a caregiver in the public health facilities, which acts as the first entry point into the public health system. From the services of a child and maternal care, family planning, immunization, minor trauma, treatment of STI, to care for referrals and chronic illnesses, the recommendations would cover the following broad scope:
The inclusion of the study population in the study design that can take more extensive longitudinal study with the addition of quantitative and qualitative components for better understanding of the ICDM model.
The ICDM model to not only address chronic diseases but also to deal with patients who do not have chronic conditions so that all the illnesses can be managed at public health care levels.
The determination of study participants and sample size should be determined on a subject-to-variable ratio so that the procedure can utilize factor analysis.
The use of multi-scale patient questionnaire should be incorporated in the study to assess different dimensions of interpersonal relations, financial capabilities, patient’s convenience and accessibility, and communication, which are critical determinants in finding out the levels of patient satisfaction.
Other few strategies in the operationalization of the Donabedian’s theoretical concept should be reflective of the SPO and should have a clear vision in the services of integrated chronic diseases. Also, a clear division of statement should be clarified in the PSQ system.
References
Allen-Duck, A., Robinson, J. C., & Stewart, M. W. (2017). Healthcare quality: A concept analysis. National Library of Medicine National Institutes of Health , 52 (4), 377-386. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640472/
Ameh, S., Gómez-Olivé, F. X., Kahn, K., Tollman, S. M., & Klipstein-Grobusch, K. (2017). Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural south african setting: applying a structural equation model. BMC Health Services Research , 17 (1). doi:10.1186/s12913-017-2177-4
Coombs, L. J., Burston, B., & Liu, D. (2017). Importance of an alternative approach to measuring quality in a volume-to-value world: a case study of diabetes care. BMJ Open Quality , 6 (2), e000216. doi:10.1136/bmjoq-2017-000216
Pecoraro, F., Luzi, D., Cesarelli, M., & Clemente, F. (2015). A methodology of healthcare quality measurement: a case study. Journal of Physics: Conference Series , 588 , 012027. doi:10.1088/1742-6596/588/1/012027
