Quality assurance

Article Abstract:

Quality assurance, as currently interpreted, applies to the outcome of medical care. At least three states have established commissions to gather data on hospitals' quality of care. Third party payment systems support these trends. Publication of outcome data encourages improvement as well as defensiveness. Risk-adjusted outcomes are commonly reported. The Health Care Financing Administration analyzed Medicare insurance claims and presented comparative mortality rates for hospitals with Medicare patients; use of this evaluation tool to screen for problems in quality care is controversial. For example, one investigator reported that there was no correlation between poor performance in New York hospitals, according to the Health Care Financing Administration's analysis, and other measures of quality. Other studies that raise related issues are discussed. Emphasis on outcomes has been strengthened by support from voluntary health organizations, such as the American Medical Association's Office of Quality Assurance. Since physicians often make clinical decisions which lack a 'hard' scientific justification, Congress has attempted to refine the decision-making process by establishing an agency to perform effectiveness research and distribute results and treatment guidelines to physicians. Rates of adverse outcomes after certain surgical procedures are being studied. These rates are higher than medical literature admits, a fact of which both physicians and patients need to be aware. Determining the relative effectiveness of alternative procedures to treat the same medical problem is quite complicated. In addition, when payment approaches change, everyone is affected; the declining mortality rate of elderly people in the 1970s levelled off after Medicare's diagnosis-related group-based prospective payment system was put into effect. Studies relating payment plans to outcome are reviewed. Four principles for improving care, within the constraints of quality control and payment plan options, are: management should give priority to both quality and finance; it is the system, not 'bad' physicians, that needs changing; purchasers and providers should work together; and the goal of continued improvement should replace specific solutions to acute problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Medical economics, Economic aspects, Reports, Quality control, Public health, Outcome and process assessment (Health Care), Outcome and process assessment (Medical care)

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The Health Care Quality Improvement Initiative

Article Abstract:

The Health Care Financing Administration (HCFA) is implementing the Health Care Quality Improvement Initiative (HCQII) to improve care for Medicare recipients. The HCQII attempts to help providers improve the mainstream of care. The HCFA will monitor the success of the initiative by measuring the extent to which practice patterns move closer to HCQII guidelines. The agency will examine changes in mortality, morbidity and cost associated with HCQII interventions or with changes in processes of care. It will also monitor reliability of the Patient Care Algorithm System (PCAS) abstracts and determine if monitoring patient care and outcomes identify significant problems which can be solved. Two new data systems, the National Claims History (NCH) file and Uniform Clinical Data Set (UCDS), will assist HCQII in evaluating Medicare bill payment records and clinical characteristics of 10% of discharged patients.

Management, Laws, regulations and rules, Social policy, Health care reform, United States. Centers for Medicare and Medicaid Services

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Quality of Medical Care Delivered to Medicare Beneficiaries: A Profile at State and National Levels

Article Abstract:

Many Medicare beneficiaries are not receiving medical care that is known to be cost-effective for certain diseases. This was the conclusion of researchers who analyzed the nationwide delivery of preventive or therapeutic care to Medicare patients for heart attack, breast cancer, diabetes, heart failure, pneumonia, and stroke.

Care and treatment, Aged, Elderly, Medical care utilization

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