The seven pillars of quality.

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 obtain the greatest 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: fairness in the distribution of care and its effects on health. 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 preference disagree the physician faces the challenge of reconciling them.