The seven pillars of quality
DONABEDIAN, A. . The seven pillars of quality. Archives of Pathology & Laboratory Medicine. Chicago, v. 114, n. 11, p.1115-1118, nov 1990.
Custos e análise de custo, Eficiência, Acesso aos serviços de saúde, Qualidade da assistência à saúde.
Seven attributes of health care define its quality: (1) efficacy: the ability of care, at its best, to improve health; (2) effectiveness: the degree to which attainable health improvements are realized; (3) efficiency: the ability to obtian the gratest health improvement at the lowest cost; (4) optimality: the most advantageous balancing of costs and benefits; (5) acceptability: conformity to patient preferences regarding accessibility, the patient-practitioner relation, the amenities, the effects of care, and the cost of care; (6) legitimacy: conformity to social preferences concerning all of the above; and (7) equity: fariness in the distribuition of care and its effects on helath. Consequently, health care professionals must take into account patient preferences as well as social preferences in assessing and assuring quality. When the two sets of preferences disagre the physician faces the challenge of reconciling them.