Continuous quality improvement: concepts and applications for physician care

Article Abstract:

Many people in the US are concerned about the quality of health care that exists today. Improvement in this area requires implementation of a quality management program. One possible model for such a program is continuous quality improvement (CQI). This model involves working to improve quality as defined by the wants and needs of the customer or patient. To use the CQI model, the attributes of quality must be defined. Quality itself is an abstract idea, but many of the attributes of quality can be defined and measured. It must also be recognized that in the pursuit of quality, there are two types of problems that can occur, systemic and extrasystemic. A systemic problem is one that is likely to occur at a given rate for a given procedure and is accepted as part of the limitations of that procedure. Costs or technology limitations prevent elimination of the risk, but the risk is considered to be outweighed by the benefits. An example is the standard aseptic technique for surgery. It greatly, but not completely, reduces the chances of postoperative infection. More extreme methods to prevent such infections are possible, but they are either too costly or interfere with the operation too much to be used. An extrasystemic problem, on the other hand, is not an accepted risk of the procedure, but occurs for some other reason that often is identifiable and can be fixed. An example would be surgery performed by a surgeon who has a highly contagious infection: the surgeon's health condition is not an accepted part of the system. Most present quality control systems focus on eliminating or solving extrasystemic problems, but not systemic problems. This does not work to increase the general quality of health care, but just to ensure that no one receives a level of quality below that a general norm. CQI works both to maintain the present quality of care by preventing extrasystemic problems and to improve the quality of care by making positive changes within the health care system. The concepts of CQI can be used by the physician in his or her practice to improve the quality of health care. They can also be applied to other health care settings to improve the quality of health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Quality management, Medical care quality, Quality control

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Periodic physician recredentialing

Article Abstract:

Cost, quality, and access are the three main issues in health care in the US, and all three are related. It has been noted that health care has progressed from an era of expansion to an era of cost containment, and an era of assessment and accountability has now begun. Quality of care has drawn attention to the process of evaluating physician performance and the implementation of periodic recredentialing. In New York State, recent cases involving medical misjudgments because of inadequate supervision of overworked medical residents have led to corrective measures. Measures to ensure that practicing physicians have met standards are under consideration, but have received resistance from physicians. Already 19 of the 23 American Boards of Medical Specialties grant a limited-time certification. However, 24 percent of New York physicians who call themselves specialists are not certified by a specialty board. The principles of recredentialing, adopted by the New York State Advisory Committee on Periodic Physician Recredentialing are discussed. Recredentialing is expected to involve peer review of compliance with standards of practice. These standards will be developed by specialists based on up-to-date information, and will change as new information becomes available. Issues such as the legality of recredentialing, who should be tested, and how the test should be structured must be addressed. A major issue is whether the medical profession will lead this process, or whether the government or other agency will impose their own guidelines on the profession. (Consumer Summary produced by Reliance Medical Information, Inc.)

New York State

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Recredentialing

Article Abstract:

Two major issues in health care are recredentialing and standard setting to assure quality care by competent practitioners and to contain costs. Twenty-three states now require continuing medical education, and 17 of 23 medical certification boards require recertification; by 1994, almost all general or subspecialty certificates will expire after 7 to 10 years. In spite of this, there is little evidence that education alone changes physician practices. Practice review is another alternative; professional standards and peer review organizations have become commonplace. However, their role has often been one of cost containment rather than professional performance review. Setting standards for all the procedures involved in all specialties, as well as for office practices, is a formidable task. Several certification boards have collected data, computerized reporting and scoring, constructed oral examinations from recent cases, or required performance data from individual physicians, including 'before-and-after' photographs from plastic surgeons. Canada has more experience in the area of office practice review, and has a well-structured system in place. Once these measures have been implemented, it is hoped that those found deficient will be given the opportunity to improve their performance. (Consumer Summary produced by Reliance Medical Information, Inc.)

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