Quality metrics in coronary artery bypass grafting

Quality may be defined differently by different individuals and the objective measurement of quality is often challenging. In the United States Institute of Medicine’s 1990 report, Medicare: A Strategy for Quality Assurance, the definition of quality included ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’. The foundational definition of quality in medicine, and certainly in surgery, comes from Avedis Donabedian’s 1966 article utilizing the triad of structure, process, and outcome. Structure refers to the inherent characteristics of the setting where care is provided, process to the particulars and procedural details of the care, and outcome to the end results of the care.