Quality care improvement

This chapter examines the relationship between quality care improvement (QCI) and sustainable community health. In clinical settings, QCI initiatives have been underway for several years. In community settings, QCI aims to improve population health outcomes (e.g., health behaviors, genetic and environmental factors, and the social determinants of health) by creating incentives that focus on prevention, and by linking medical care with community-and population-based interventions. We outline key milestones in the history and evolution of QCI applied to community health in the US context, including the landmark reports published by the Institute of Medicine and the passage of the Affordable Care Act, which led to the development of many new QCI models. Next, we discuss the current approaches to QCI in the context of community health, highlighting many state models, including those of Oregon and California, which have demonstrated success in developing initiatives that address both medical and nonmedical quality improvement. We follow this by considering prospective or emerging QCI approaches to community health. Moreover, we enumerate some of the cultural, professional, and legal issues that influence how QCI is applied in community settings, and especially the role of community health workers and the sharing of data. Finally, we discuss research and practice issues that affect QCI implementation in community health care in light of relevant historical issues, new theories and trends, and expanded quality measures.