From "Three Mile Island" to the "Stars": The Construction of Quality in US Health Care.

Using an inductive approach involving topic modeling, word co- occurrences and historical analysis, we investigate how the concept of "quality" in health care and the vocabularies of quality evolved from 1993 to 2015. We find that the vocabularies of quality have been structured around two main topics or higher- order vocabulary dimensions involving: (1) the measurement of quality; and (2) the organization of quality care. We trace the temporal evolution of these two dimensions over the study period, conduct between- topic analyses to examine the distribution of attention between these two dimensions where usage of the term "quality" is explicit and other topics in which the notion of quality is implicitly embedded, and use analyses of word co- occurrences to investigate more fine-grained changes in word- to- word relationships relevant to our two primary dimensions of interest. By means of insights from our historical analysis, we propose three mechanisms responsible for the changes in vocabularies over time: (1) crisis events as windows of opportunity to engage in meaning-making activities; (2) system- wide search for solutions to crisis; and (3) an accountability- focused rational scientific imperative that eroded the autonomy of those purportedly liable for the crisis. [ABSTRACT FROM AUTHOR]