Quality of care and evaluating services

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Abstract
Quality of care and the evaluation of services is of growing concern throughout the world, partly because of increased need for value for money in health care. Quality of health care needs to include effectiveness, acceptability and humanity, equity and accessibility, and efficiency. Numerous mechanisms exist to monitor and improve the quality of care for patients and families. These can be carried out either locally by the clinicians or managers, or externally by national or international organizations. The quality assessment can consider the care of individual or a few patients, or the care provided by the whole organization or to a whole population. The type of appropriate quality monitoring is usually determined by the setting and aims. Evaluations of community services have assessed patient depression, quality of life and carer burden and stress, and although support programmes and home care services have shown benefits, few interventions have been evaluated in isolation and the best combinations of care are not known. Services offered by general practitioners are largely unevaluated. Evaluations of domiciliary and community support teams are in progress and, as yet, results are contradictory. Evidence from other evaluations to date have demonstrated a degree of effectiveness, humanity and acceptability for specific and targeted services for elderly people with mental health problems. There is a need for further work in the development of suitable outcome measures for this area of care, particularly those that are clinically useful and sensitive to change.