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Editorial
. 2023 Jan;38(1):203-207.
doi: 10.1007/s11606-022-07781-1. Epub 2022 Sep 20.

Directly Observed Care: Crossing the Chasm of Quality Measurement

A Taylor Kelley  1   2   3 , Saul J Weiner  4   5 , Joseph Francis  6
Affiliations
Editorial

Directly Observed Care: Crossing the Chasm of Quality Measurement

A Taylor Kelley et al. J Gen Intern Med. 2023 Jan.

Abstract

After more than two decades of national attention to quality improvement in US healthcare, significant gaps in quality remain. A fundamental problem is that current approaches to measure quality are indirect and therefore imprecise, focusing on clinical documentation of care rather than the actual delivery of care. The National Academy of Medicine (NAM) has identified six domains of quality that are essential to address to improve quality: patient-centeredness, equity, timeliness, efficiency, effectiveness, and safety. In this perspective, we describe how directly observed care-a recorded audit of clinical care delivery-may address problems with current quality measurement, providing a more holistic assessment of healthcare delivery. We further show how directly observed care has the potential to improve each NAM domain of quality.

Keywords: directly observed care; healthcare quality; patient-centered care; unannounced standardized patients.

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Conflict of interest statement

SJW is a Principal of the Institute for Practice and Provider Performance Improvement (I3PI), founded to employ unannounced standardized patient assessments as a quality improvement service. There are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Holistic quality measurement throughout the cycle of healthcare delivery.
See this image and copyright information in PMC

References

    1. Institute of Medicine (National Academy of Medicine) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US). Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.
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