Frameworks for Health Care Quality and Disparities in Health Care Quality: A Scoping Review

Quality-of-care frameworks are essential for assessing health care system performance, addressing disparities, and guiding quality improvement. The aim of the project was to identify and appraise such frameworks for health care delivery settings.

A scoping review (protocol: osf.io/cegq3) searched seven research databases for quality-of-care frameworks published through October 2024. We also reviewed websites of health services research organizations and agencies charged with monitoring quality of care and/or health care disparities. Eligible publications addressed quality-of-care measures, indicators, criteria, or benchmarks; included a visualization or structured description differentiating quality domains; and were applicable to health care.

We identified 154 frameworks proposed by national and international entities. Critical appraisal showed 49% of frameworks were constructed with input from interest holders, 29% described an evidence-based process, and 36% reported validity testing. Frameworks varied in complexity and scope, and inclusion of disparities as a framework component increased over time. The most frequent framework domains were access, structural capabilities, equity, and effectiveness; however, definitions and conceptualizations varied.

Our findings show that there remains much work to be done to refine and operationalize health care quality frameworks to ensure they can be applied effectively across health care settings to drive real-world improvements in quality and equity of care.