| This programme is aimed at methods, tools and policies to assess and improve the quality, efficiency and organisation of care. The focus is on quality of care as defined by professionals (professional quality), as judged by those who receive care (patient-directed quality), and as defined by policy-makers and financers (policy-directed quality). Two complementary lines of approach are consistently followed: (1) analysis and improvement of the quality of the individual care process, and (2) influencing conditions for optimal care by organisation, management and regulation.The research addressed by the first line, focuses on the quality of patient-oriented processes of care, and concerns the degree to which criteria for adequate care are met. Central is the quality improvement circle: based on an analysis of the bottlenecks in the process and outcomes of care, indicators of quality of care and clinical guidelines are developed; actually provided care is tested against these guidelines; subsequently the quality of care is actively influenced according to the guidelines developed; results are evaluated and bottlenecks are analysed again, possibly leading to further adaptations. Attention is paid to general practice, allied health care and nursing care. An important subject is the co-operation between generalist and specialist care in relation to the quality of existing and innovative integrated care. The value of computerisation in general practice and computerised information exchange and communication between primary and secondary care for the purpose of quality of care improvement is explored. Also the patients role in shared decision-making is an increasing field of interest. The second line in this programme addresses the policy preconditions, possibilities and organisational interventions for promoting optimal extramural and integrated health care provision. Both improvement of existing care and innovation of care are studied. Possibilities of influencing policies at meso- and macro-level are evaluated. Important at the meso-level is the organisation of care (such as local district care for the elderly and disabled, and the relation between home care and informal care). Also the efficiency of health care provision is analysed, using health economical methods and health care technology assessment (HCTA). At macro-level attention is paid to (actors in) policy-making, legislation and ethics, financing and determi-ning health care fees, and interventi-ons on the behaviour of professions and the quality of care. It is also investiga-ted to what extent national and multinational disease-specific scenario-analyses and cost-effectiveness analyses can support health care policy. |
