A nurse has just finished providing teaching and care to a child with type 1 diabetes. On the basis of the five dimensions of healthcare identified by the Institute of Medicine, indicators of quality care include that the child: (Select all that apply.)
A) Safely self-injected insulin in the office
B) Has maintained an appropriate blood glucose level consistently for 6 months
C) Was seen by the nurse 2 hours after arriving for a scheduled appointment
D) Received care that was identical to that provided to six other clients of various racial backgrounds
E) Received instructions directly from the nurse in the office, not via a parent
Ans: A, B, D, E
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The Institute of Medicine lists the following dimensions of healthcare systems that should be considered when quality, cost, and access are examined: 1) safety: avoiding injury and harm from care that is meant to aid clients; 2) effectiveness: assuring that "evidence-based" care is actually delivered, by avoiding overuse of medically unproven care and underuse of medically sound care; 3) client-centeredness: involving clients thoroughly in the decision-making process about their care, thereby respecting their culture, social circumstances, and needs; 4) timeliness: avoiding unwanted delays in treatment; and 5) equality: closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes.
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