Index

A

Accountability, 2, 24, 26

see also Outcome measures;

Performance measures

clinical quality measurement, 4, 26, 58, 84, 110, 139

diabetes care, 158-161

Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 24

Advisory Committee on Regulatory Reform, 49, 87

Age factors

see also Children;

Elderly persons;

Medicare;

State Children’s Health Insurance Program

Medicaid beneficiaries, 33, 34, 35, 49

TRICARE, 35-36

Agency for Healthcare Research and Quality (AHRQ), 6, 7-8, 13, 14, 17, 59, 70, 72, 74, 83, 129, 131-135, 138, 142, 143, 147, 150

Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141

information technology, 109, 125

AIDS, see HIV/AIDS

American Board of Internal Medicine, 39-40

American College of Physicians, 39-40

American Health Quality Association, 171

American Hospital Association (AHA), 49

American Indians, see Indian Health Service;

Native Americans

American Medical Association, 85(n.2)

American National Standards Institute, 171

American Society of Internal Medicine, 40

Association for Ambulatory Health, 64

Attitudes and beliefs, 25, 37-41

Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141

patient-centered care, 37, 39-41, 48

B

Balanced Budget Acts, 49, 68, 96

Beliefs, see Attitudes and beliefs

Benchmarking, 12, 13, 67, 72, 101

information capabilities, 109

research on, 134

State Children’s Health Insurance Program (SCHIP), 97

Veterans Health Administration (VHA), 70

Best practices, 7, 8, 13, 56, 57, 58, 101

information technology, 109



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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality Index A Accountability, 2, 24, 26 see also Outcome measures; Performance measures clinical quality measurement, 4, 26, 58, 84, 110, 139 diabetes care, 158-161 Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 24 Advisory Committee on Regulatory Reform, 49, 87 Age factors see also Children; Elderly persons; Medicare; State Children’s Health Insurance Program Medicaid beneficiaries, 33, 34, 35, 49 TRICARE, 35-36 Agency for Healthcare Research and Quality (AHRQ), 6, 7-8, 13, 14, 17, 59, 70, 72, 74, 83, 129, 131-135, 138, 142, 143, 147, 150 Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141 information technology, 109, 125 AIDS, see HIV/AIDS American Board of Internal Medicine, 39-40 American College of Physicians, 39-40 American Health Quality Association, 171 American Hospital Association (AHA), 49 American Indians, see Indian Health Service; Native Americans American Medical Association, 85(n.2) American National Standards Institute, 171 American Society of Internal Medicine, 40 Association for Ambulatory Health, 64 Attitudes and beliefs, 25, 37-41 Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141 patient-centered care, 37, 39-41, 48 B Balanced Budget Acts, 49, 68, 96 Beliefs, see Attitudes and beliefs Benchmarking, 12, 13, 67, 72, 101 information capabilities, 109 research on, 134 State Children’s Health Insurance Program (SCHIP), 97 Veterans Health Administration (VHA), 70 Best practices, 7, 8, 13, 56, 57, 58, 101 information technology, 109

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality Blue Shield, 48 Bureau of Health Professions, 60 Bureau of Primary Health Care, 60 Buyers Health Care Action Group, 47 C Cancer, 24, 86, 91, 99, 137 National Cancer Institute, 134, 138-139 Cancer Care Outcomes and Surveillance Consortium, 138-139 Capitation, 44-45, 59 Cardiac disease, 69, 86, 90, 91, 94, 99, 134, 136, 139 Centers for Disease Control and Prevention, 59, 72, 130, 134, 137, 139 Centers for Medicare and Medicaid Services (CMS), 3, 17, 18, 64, 65, 66, 68-69, 72, 97 see also Medicaid; Medicare; State Children’s Health Insurance Program End Stage Renal Disease Networks, 3, 85, 93 information technology, 117, 120 Medical Statistical Information Set, 114 Outcome Assessment and Information Set (OASIS), 84, 86, 87, 95 performance measures, other, 81, 85, 86, 87-95, 96, 103, 133 Quality Improvement System for Managed Care, 66 research agenda, 133, 134, 135-137, 139 Centers of Excellence, 68, 69, 72 Centralized Quality Assurance System, 168 Children see also State Children’s Health Insurance Program Indian Health Service (IHS), 100 Medicaid, 33, 34, 35, 49 Chronic conditions, 44, 145 see also Diabetes; Disabled persons; Institutional care; Nursing homes capitation, 44-45, 59 cardiac, 69, 86, 90, 91, 94, 99, 134, 136, 139 expectations and needs of beneficiaries, 37-39 Medicaid, 33-34, 42 Medicare, 29-32, 33, 38, 42-43, 69 obesity, 40, 99 patient-centered care, 40 renal disease, 3, 29, 85, 93, 95 State Children’s Health Insurance Program (SCHIP), 43 veterans, 38, 43, 44, 99 Chronic Disease Care Index, 99 Clinical performance measures, 4, 26, 58, 84, 110, 139 Common procedure terminology, 163 Composite Health Care System, 115, 167 Computer technology, general, 4-5, 8, 11-13, 56, 74, 108-128, 132 see also Internet Agency for Health Care Research and Quality, 109, 125 architecture of systems, 12, 70, 112, 162, 163-169 (passim) Department of Defense, 4-5, 11, 26, 117 Indian Health Service (IHS), 48, 109, 116, 120 medical errors, 108, 113, 114, 121, 165-166, 168-169 Medicare, 108, 113-114 State Children’s Health Insurance Program (SCHIP), 5, 108, 113 tax credits, 12, 108, 119-120 TRICARE, 5, 108-109, 113, 114, 116, 162, 166, 169 Veterans Health Administration, 4-5, 26, 109, 114-116, 120, 139-141, 162-166 Computerized patient record systems, 4-5, 11-13, 67, 75-76, 80, 109, 110-112, 114-118, 164-169 (passim) confidentiality and privacy, 13-14, 16, 49, 109, 112, 125 Department of Defense, 4-5, 11, 26, 117 hospitals, 110-111 incentives for adopting, 12, 108, 109, 112, 118, 119-120, 121 Indian Health Service (IHS), 48, 109, 116, 120 Internet, 109, 116, 121, 169 pharmaceuticals, 110-111 purchasing strategies, 68 standardization, 110, 111, 112-113, 117 Computerized patient records, 4-5, 8, 11-13, 39, 108-110, 145, 162-169 (passim)

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality Confidentiality and privacy, 13-14, 16, 49, 109, 112, 125 CONQUEST, 132 Consolidated Health Informatics Initiative, 113, 117 Consolidated Omnibus Reconciliation Act, 66 Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141 Consumer input, general, 6, 71, 74, 75 Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141 insurance, information capabilities, 109 patient-centered care, 37, 39-41, 100, 130, 135, 145-146 program design and administration, 48 Contracting, 3, 36, 48, 59, 61, 65, 67, 68, 71, 85, 88, 93, 103, 118-120 Copayments, 42-43, 44, 47 Cost factors, 1 see also Economic factors; Funding capitation, 44-45, 59 clinical records, 110 copayments, 42-43, 44, 47 information technology, 110, 112 Outcome Assessment and Information Set (OASIS), 87 research on, 131 risk adjustment, 45, 59, 67-68, 85-86, 101, 140-141, 149 TRICARE, 36 Crossing the Quality Chasm: A New Health System for the 21st Century, 2, 24 Cultural factors, 100 patient-centered care, 40-41 D Defense Blood Standard System, 167 Defense Medical Logistics Standard Support System, 167-168 Demonstration projects, 16, 59, 68-69, 79-80, 111, 135-137, 141 Department of Defense see also TRICARE health information systems, 4-5, 11, 26, 117 Military Health System (MHA), 115-116, 120, 166-169 Military treatment facilities, 36 performance measures, 9, 79 Department of Health and Human Services (DHHS), 9, 134 see also Centers for Medicare and Medicaid Services; Indian Health Service; Medicaid; Medicare; State Children’s Health Insurance Program Advisory Committee on Regulatory Reform, 49, 87 Agency for Healthcare Research and Quality (AHRQ), 6, 7-8, 13, 14, 17, 59, 70, 72, 74, 83, 129, 131-135, 138, 142, 143, 147, 150 Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141 information technology, 109, 125 Food and Drug Administration, 72 Health Resources and Services Administration, 137-138, 139, 141 National Cancer Institute, 134, 138-139 National Health Care Purchasing Institute, 46-47 National Heart, Lung, and Blood Institute, 139 National Institute of Diabetes and Digestive and Kidney Diseases, 139 National Institutes of Health (NIH), 59, 60, 130, 138-139, 142 performance measures, 9, 10, 79, 86(n.3), 87, 101 Department of Veterans Affairs see also Veterans Health Administration computerized clinical data, 11 dual eligibility, 29 performance measures, 9, 79 regulatory issues, 58, 60, 64, 65 research agenda, 139 Diabetes, 136, 139, 141, 158-161 Diabetes Quality Improvement Project (DQIP), 26, 80, 82, 83-85, 125, 135, 141 Internet information, 40 Medicaid, 34, 39

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality Medicare, 86, 91 performance, 26, 80, 82, 83-85, 158-161 Translating Research into Action for Diabetes, 137 veterans, 99 Diabetes Research and Training Centers, 139 Dialysis, see End Stage Renal Disease Networks Digital Imaging and Communications in Medicine Disabled persons see also Chronic conditions expectations and needs of beneficiaries, 37-39 veterans, 35, 43 Drugs, see Pharmaceuticals Dual eligibility, 9, 29 E Economic factors, 2, 6, 21, 28 see also Cost factors; Funding; Insurance; Poverty; Tax policy beneficiaries/expenditures, 3, 21, 29, 30-33 capitation, 44-45, 59 contracting, 3, 36, 48, 59, 61, 65, 67, 68, 71, 85, 88, 93, 103, 118-120 incentives, 2, 6, 11-12, 16, 18, 44, 58, 75 alternative payment models, 146-147 chronic conditions, 38 fee-for-service, 46-48 grants, 12, 35, 69, 108, 118, 119-120 information technology, 12, 108, 109, 112, 118, 119-120, 121 performance measures, 58-59, 67, 134, 146-147 information technology, 12, 108-112 (passim), 118, 119-120, 121 purchasing strategies, 7, 8, 10, 22, 23, 48, 56, 58, 59, 60, 67-69, 74-75 Education, see Patient education; Professional education; Public education Educational attainment Indian Health Service enrollees, 37 Elderly persons Medicaid, 34, 43, 66 Emergency care TRICARE, 36 Emergency Medical Treatment and Active Labor Act, 89 Employers’ Coalition on Health, 47 End Stage Renal Disease Networks, 3, 85, 93, 95 European Federation of Internal Medicine, 40 External Quality Review Organizations (EQRO), 62, 65-67, 84, 86(n.4), 92 F Federal Employees Health Benefits Program, 69 Federal Health Information Exchange, 117 Fee-for-service, 4, 45-48 design and administration, 48-49 historical perspectives, 23-24 Medicare, 50, 62, 66, 68, 69, 88, 113 performance measures, 45-46, 47-48 physicians, 45-46 quality improvement organizations (QIOs), 3, 17, 66, 88-93, 103, 113-114, 133-134, 136 Females, see Gender factors Food and Drug Administration, 72 Foundation for Accountability, 80 Funding, 1, 5, 7, 28, 86, 103 see also Cost factors End Stage Renal Disease Network, 93 grants, 12, 35, 69, 108, 118, 119-120 Indian Health Service (IHS), 44 Medicaid, 33 Medicare, 103 performance measures, 83 professional training, 60 quality improvement organizations (QIOs), 89 research, 7, 130, 131 G Gender factors, 100 Medicaid, 49 General Motors, 48 Geographic factors, 24, 95, 100, 101 see also State-level issues computerized patient records, 111, 125 nursing homes, 95 Grants, 12, 35, 69, 108, 118, 119-120

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality H Handicapped persons, see Disabled persons Health Care Financing Administration, see Centers for Medicare and Medicaid Services Health Care Quality Improvement Program, 144 Health Insurance Portability and Accountability Act, 112, 125 Health maintenance organizations Medicare, 30 Health Outcomes Survey (HOS), 62, 85, 92 Health Plan Employer Data and Information Set (HEDIS), 17, 62, 66, 68, 69, 70, 71, 84, 85, 92, 96, 97, 98, 113, 121 Health Resources and Services Administration, 137-138, 139, 141 Healthcare Research and Quality Act, 2, 22 Heart disease, see Cardiac disease Hill-Burton Act, 119 Historical perspectives, 23-24 Internet, 121 performance measures, 81 regulatory issues, 58, 61, 66-67: see also Legislation HIV/AIDS, 138 Home health care, 38, 39, 42, 50, 65, 66, 92-93, 95 Hospitals, 12, 38 claims data, 110 computerized patient records, 110-111 Indian Health Service (IHS), 37 insurance, 41, 48, 49 Medicare, 91 performance measures, 4, 58, 66, 86, 91, 94, 122 veterans, 35, 99 Human immunodeficiency virus/acquired immunodeficiency syndrome, see HIV/AIDS I Incentives, 2, 6, 11-12, 16, 18, 44, 58, 75 see also Tax policy alternative payment models, 146-147 chronic conditions, 38 fee-for-service, 46-48 grants, 12, 35, 69, 108, 118, 119-120 information technology, 12, 108, 109, 112, 118, 119-120, 121 performance measures, 58-59, 67, 134, 146-147 Indian Health Service (IHS), 36-37, 71 beneficiaries/expenditures, 3, 31, 37 children, 100 committee study charge, 1, 22 design and administration, 48 diabetes, 70, 71 dual eligibility, 29 hospitals, 37 information capabilities, 48, 109, 116, 120 Medicare/Medicaid and, 64 performance measures, 84, 99-100 regulatory issues, 60, 64, 65, 70 Information technology, see Internet Institutional care, 9 see also Hospitals DOD TRICARE, 31 insurance, general, 42 Medicaid, 33, 43, 95 Medicare, 85-86, 95 nursing homes, 3, 35, 38, 41, 42, 50, 68, 83, 85-86, 88, 95 performance measures, 85-86, 93, 95 regulatory issues, 50, 95 standards, 2, 9, 22 veterans, 35, 36 Insurance, 41-44 see also Fee-for-service; Health maintenance organizations; Managed care; Medicaid; Medicare; State Children’s Health Insurance Program alternative payment models, 146-147 capitation, 44-45, 59 chronic conditions, 42 claims data, 110 copayments, 42-43, 44, 47 design and administration, 48-49 dual eligibility, 9, 29 hospitalization, 41, 48, 49 institutional care, 42 medical errors, 48 risk adjustment, 45, 59, 67-68, 85-86, 101, 140-141, 149 performance measures, 58, 110 pharmaceuticals, 42 Interdisciplinary approaches, see Multidisciplinary approaches

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality Internet agency sites, selected list of, 171 clinical information retrieval, 109, 116, 121, 169 diabetes, 40 End Stage Renal Disease Network, 93, 95 patient-centered care, 40-42, 166, 169 regulatory issues, 65 J Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 64, 65, 69, 71, 80, 85, 99, 103 ORYX, 93, 94 K Keystone Peer Review Organization, 67 Kidney disease, see Renal disease L Leapfrog Group, 10, 80, 101, 103 Legislation, 8, 72, 73, 103 see also Regulatory issues Balanced Budget Acts, 49, 68, 96 Consolidated Omnibus Reconciliation Act, 66 Emergency Medical Treatment and Active Labor Act, 89 End Stage Renal Disease Network, 93 Health Insurance Portability and Accountability Act, 112, 125 Healthcare Research and Quality Act, 2, 22 Hill-Burton Act, 119 Medicaid, general, 66 Medicare, general, 3, 66 Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act, 86 M Males, see Gender factors Malpractice, see Medical errors and malpractice Managed care, 33 design and administration, 48-49 health maintenance organizations, 30 Medicaid, 33, 45 Medicare, 30, 62-63, 66-67, 88 State Children’s Health Care Program, 35 Massachusetts General Hospital Utility Multi-Programming System, 163 Medicaid, 17, 32-34, 73, 138 see also Centers for Medicare and Medicaid Services beneficiaries/expenditures, 3, 30-34 benefits and copayments, 43 capitation, 45 children, 33, 34, 35, 49 chronic conditions, 33-34, 42 committee study charge, 1, 22 design and administration, 49 diabetes, 34, 39 elderly persons, 34, 43, 66 eligibility, 32, 34 fee-for-service, 66, 113-114 gender factors, 49 information capabilities, 108, 113-114 institutional care, 33, 43, 95 managed care, 33, 62-63, 66-67, 96, 97 Medicare participants, 29 performance measures, 4, 58, 62, 80, 81, 84, 96-97, 103, 138, 146 pharmaceuticals, 43 quality improvement organizations (QIOs), 3, 17, 66, 88-93, 103, 113-114, 133-134, 136 regulatory issues, 58, 60, 61, 62-63, 66-67 Medicaid Management Information System, 114 Medical errors and malpractice, 2, 4-7 (passim), 24, 25, 28, 82, 101-102 consumer awareness of, 6, 7 federal agency coordination in rectification, 60, 66, 67, 71, 72, 74 information technology and, 108, 113, 114, 121, 165-166, 168-169 insurers and, 48 program participation standards, 61 research on, 12, 24, 130, 131-132, 139-140 standards, 65 Medical Expenditure Panel Survey, 31 Medical Statistical Information Set, 114 Medicare, 29-32, 133, 144 see also Centers for Medicare and Medicaid Services

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality beneficiaries/expenditures, 3, 29-30, 33 benefits and copayments, 42-43, 44 chronic conditions, 29-32, 33, 38, 42-43, 69 committee study charge, 1, 22 design and administration, 48, 49, 50 diabetes, 86, 91 fee-for-service, 50, 62, 66, 68, 69, 88, 113 health maintenance organizations, 30 hospitals, 91 information capabilities, 108, 113-114 institutional care, 85-86, 95 managed care, 30, 62-63, 66-67, 88 Medicaid participants, 29 mental diseases and disorders, 32, 42 performance measures, 3, 4, 58, 68, 80, 81, 84, 88-95, 103 pharmaceuticals, 36, 49 purchasing strategies, 68 quality improvement organizations (QIOs), 3, 17, 66, 88-93, 103, 113-114, 133-134, 136 regulatory issues, 58, 60-69 (passim), 73, 88 renal disease, 29, 85, 93, 95 Scope of Work (SOW), 89, 90, 93, 97 Medicare+Choice (M+C), 30, 48, 49, 50, 58, 66, 68, 88, 90, 93 Medicare Coordinated Demonstration Projects, 111 Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act, 86 Mental diseases and disorders, 42-43, 100 Medicare recipients, 32, 42 Military Health System (MHA), 115-116, 120, 166-169 Military personnel, see Department of Defense; TRICARE Military treatment facilities, 36 Minimum data set (MDS), 85-86, 95 Minority groups, see Race/ethnicity Multidisciplinary approaches patient-centered care, 40 My Healthy Vet program, 115, 166 N National Cancer Institute, 134, 138-139 National Center for Patient Safety, 71 National Committee for Quality Assurance (NCQA), 17, 45, 66, 69, 80, 85(n.2), 96, 103, 123 National Committee on Vital and Health Statistics, 171 National Council for Prescription Drug Programs, 171 National Diabetes Quality Improvement Alliance, 85(n.2) National Health Care Purchasing Institute, 46-47 National Healthcare Quality Report, 10 National Heart, Lung, and Blood Institute, 139 National Institute of Diabetes and Digestive and Kidney Diseases, 139 National Institutes of Health (NIH), 59, 60, 130, 138-139, 142 Agency for Healthcare Research and Quality (AHRQ), 6, 7-8, 13, 14, 17, 59, 134 National Mail Order Pharmacy Program, 167 National Measures Clearinghouse, 132 National Medicare Education Program, 68 National Patient Information Reporting System, 116 National Quality Forum (NQF), 80, 85(n.2), 101, 103 National Quality Report, 134 National Roundtable on Health Care Quality, 24 National Surgical Quality Improvement Program, 71, 99 Native Americans, 29 see also Indian Health Service Nursing homes, 3, 35, 38, 41, 42, 50, 68, 83, 85-86, 88, 95 O Obesity, 40, 99 ORYX, 93, 94 Outcome Assessment and Information Set (OASIS), 84, 86, 87, 95 Outcome measures, general, 22, 23, 75, 80, 81, 82, 84 see also Medical errors and malpractice; Performance measures

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality diabetes, 26 design and administration, 48-49, 83, 84 research on, 132-133, 136, 140-141 Outcomes-Based Quality Improvement Technology, 136 P PacifiCare, 47 Patient education, 6, 18, 22, 74, 122, 140, 147-150 see also Patient-centered care; Public education diabetes, 39 Internet, 40-41 Medicare, 43 Patient Outcomes Research Team, 132 Patient Safety Centers of Inquiry, 139-140 Patient Safety Data Standards, 113 Patient-centered care, 37, 39-41, 100, 130, 135, 145-146 Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141 Internet, 40-42, 166, 169 physicians, 39-40 Performance measures, 2-4, 6, 7, 9, 11, 13, 25, 58-59, 67, 71, 74, 79-107 see also Benchmarking; Medical errors and malpractice; Outcome measures; Reporting requirements analysis of data, 26 best practices, 7, 8, 13, 56, 57, 58 Centers for Medicare and Medicaid Services (CMS), 81, 85, 86, 87-95, 96, 103, 133 clinical, 4, 26, 58, 84, 110, 139 Department of Defense, 9, 79 diabetes care, 26, 80, 82, 83-85, 158-161 fee-for-service, 45-46, 47-48 hospitals, 4, 58, 66, 86, 91, 94, 122 incentives for adopting, 58-59, 67, 134, 146-147 Indian Health Service (IHS), 84, 99-100 information technology and, 109, 110-112, 122-125 institutional care, 85-86, 93, 95 insurance, 58, 110 Medicaid, 4, 58, 62, 80, 81, 84, 96-97, 103, 138, 146 Medicare, 3, 4, 58, 68, 80, 81, 84, 88-95, 103 participation standards, 61-65 physicians, 58, 61, 64, 91 purchasing strategies, 67-68 research on, 132-145 (passim) small-practice settings, 145 standardized, 4, 6, 9, 10-11, 14-15, 26, 101-104, 110, 117, 129, 144 State Children’s Health Insurance Program (SCHIP), 4, 58, 62, 67, 84, 87, 97, 103-194 state-level issues, 3, 4, 59, 81, 96-97, 103 TRICARE, 84, 100 types of, 81-82 Veterans Health Administration (VHA), 84, 99, 163, 165-166 Pharmaceuticals computerized patient records, 110-111 Medicaid, 43 Medicare, 36, 49 insurance, general, 42 State Children’s Health Insurance Program (SCHIP), 34 TRICARE, 36, 167 Pharmacy Data Transaction Service, 167 Physicians, 26 capitation, 44-45 fee-for-service, 45-46 licensure, 61, 64 patient-centered care, 39-40 performance measures, 58, 61, 64, 91 Poverty, 100 see also Medicaid; State Children’s Health Insurance Program Indian Health Service (IHS), 37 Preventive care chronic conditions, 38 fee-for-service, 46 TRICARE, 36 Privacy, see Confidentiality and privacy Professional education, 22-23, 60 information capabilities, 109 Public education, 22, 58, 68, 75, 147-150 see also Patient education Consumer Assessment of Health Plans (CAHPS), 62, 66-67, 68, 69, 70-71, 83, 84, 85, 92, 96-99 (passim), 121, 133-134, 136, 138, 141

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality information technology and, 40-42, 121-125 (passim) Purchasing strategies, 7, 8, 10, 22, 23, 48, 56, 58, 59, 60, 67-69, 74-75 Q Q-Span, 132 Quality assurance, general, 2-5, 22-25, 39, 41, 57, 69-70 see also Accountability; Performance measures; Regulatory issues; Standards clinical quality measurement, 4, 11-12, 26, 58 committee recommendations, 1, 4-18 (passim), 28 committee study charge, 1, 22-23 definitional issues, 21, 22 expectations and needs of beneficiaries, 37-41 historical perspectives, 23-24 Quality Enhancement Research Initiative, 139, 140-141 Quality improvement organizations (QIOs), 3, 17, 66, 88-93, 103, 113-114, 133-134, 136 Quality Improvement System for Managed Care, 66 Quality Interagency Coordination Task Force (QuIC), 72, 82, 134-135, 142 committee recommendations, 1, 10-11, 14, 15, 17, 18, 79, 80, 103, 129, 130 R Race/ethnicity, 100 see also Indian Health Service; Native Americans patient-centered care, 40-41 Regulatory issues, 6, 7, 23, 25, 49-50, 56, 57-59, 60-74 (passim) see also Legislation; Performance measures; Standards; Tax policy committee recommendations, 1, 15 confidentiality and privacy, 13-14, 16, 49, 109, 112, 125 Department of Veterans Affairs, 58, 60, 64, 65 historical perspectives, 58, 61, 66-67 Indian Health Service (IHS), 60, 64, 65, 70 information technology, 108, 111, 118-119 institutional care Internet, 65 Medicaid, 58, 60, 61, 62-63, 66-67 Medicare, 58, 60-69 (passim), 73, 88 physician licensure, 61, 64 State Children’s Health Insurance Program (SCHIP), 58, 60, 61, 62-64, 97, 103-104 state-level, other, 59, 60, 61-65 (passim), 96-97, 103-104 TRICARE, 58, 60, 64, 65, 67, 69-71 Veterans Health Administration (VHA), 60, 64, 67 Renal disease, 29 End Stage Renal Disease Networks, 3, 85, 93, 95 Medicare, 29, 85, 93, 95 Reporting requirements, 26, 72, 81, 96-97, 148 committee study charge, 22 Consumer Assessment of Health Plans, 62, 66-67 electronic, 108, 121-123, 165-166 Outcome Assessment and Information Set (OASIS), 84, 86, 87, 95 standardization, 9, 10, 15, 26, 80, 104 Research agendas, 6, 7, 14-15, 26, 129-152 see also Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention ; National Institutes of Health Centers for Medicare and Medicaid Services (CMS), 133, 134, 135-137, 139 demonstration projects, 16, 59, 68-69, 79-80, 111, 135-137, 141 medical errors, 12, 24, 130, 131-132, 139-140 outcome measures, 132-133, 136, 140-141 performance measures, 132-145 (passim) time lags before clinical practice, 132-133 Respiratory disease, 28, 81, 86, 90, 92, 99

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality Reward Results initiative, 147 Risk factors risk adjustment, 45, 59, 67-68, 85-86, 101, 140-141, 149 TRICARE, 36 vulnerable populations, 44 Robert Wood Johnson Foundation, 46-47, 134, 147 S Safety (malpractice and medical errors), see Medical errors and malpractice Safety-net providers, 12, 119 Scope of Work (SOW), Medicare, 89, 90, 93, 97 SEER, see Surveillance, Epidemiology, and End Results Standards, 8, 24, 70-72 see also Benchmarking; Regulatory issues best practices, 7, 8, 13, 56, 57, 58, 101, 109 computerized patient records, 110, 111, 112-113, 117 institutional care, 2, 9, 22 performance measures, 4, 6, 9, 10-11, 14-15, 26, 101-104, 110, 117, 129, 144 practice standards, other, 24, 57 provider participation in programs, 2, 61-65 reporting, 9, 10, 15, 26, 80, 104 State Children’s Health Insurance Program (SCHIP), 17, 34-35, 130 see also Centers for Medicare and Medicaid Services beneficiaries/expenditures, 3, 30-31 benefits and copayments, 43 chronic conditions, 43 committee study charge, 1, 22 eligibility, 34-35 fee-for-service, 97 information capabilities, 5, 108, 113 participation standards, 65, 67 performance measures, 4, 58, 62, 67, 84, 87, 97, 103-194 pharmaceuticals, 34 regulatory issues, 58, 60, 61, 62-64, 97, 103-104 State-level issues, 17-18 Indian Health Service (IHS), 37 information capabilities, 109 Medicaid, 17, 30, 33, 38-39, 42-43, 96-97, 103, 130, 146 Medicare, 3, 30, 42, 87-95 performance measures, 3, 4, 59, 81, 96-97, 103 professional licensure, 61, 64 public education, 148-149 regulatory issues, 59, 60, 61-65 (passim), 96-97, 103-104 scope-of-practice rules, 61, 64 tax policy, 60 Stroke, 31, 86, 90, 92 Substance Abuse and Mental Health Services Administration, 134 Surveillance, Epidemiology, and End Results (SEER), 139 T Tax policy, 60 computer technology, 12, 108, 119-120 Theater Medical Information Program, 115-116, 166, 169 Translating Research into Action for Diabetes, 137 Translating Research Into Practice, 132-133, 138 TRICARE, 35-36, 69-70, 71 beneficiaries/expenditures, 3, 31 Centers of Excellence, 69 committee study charge, 1, 22-23 design and administration, 48, 100 emergency care, 36 information capabilities, 5, 108-109, 113, 114, 116, 162, 166, 169 institutional care, 31 Medicare and, 36 military treatment facilities, 36 performance measures, 84, 100 pharmaceuticals, 36, 167 regulatory issues, 58, 60, 64, 65, 67, 69-71 V Veterans Administration, see Department of Veterans Affairs Veterans Health Administration (VHA), 35, 59, 70, 71, 139-141 beneficiaries/expenditures, 3

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Leadership by Example: Coordinating Government Roles in Improving Health Care Quality benefits and copayments, 43, 44 chronic conditions, 38, 43, 44, 99 committee study charge, 1, 22 design and administration, 48 disabled, 35, 43 eligibility, 35 health information systems, 4-5, 26, 109, 114-116, 120, 130-141, 162-166 hospitals, 35, 99 institutional care, 35, 36 performance measures, 84, 99, 163, 165-166 regulatory issues, 60, 64, 67 Veterans Health Information Systems and Technology Architecture, 163 Veterans Integrated Service Networks, 35 VISTA, 70 Vulnerable populations see also Poverty State Children’s Health Care Program (SCHIP), 35 W Waiver programs, 66 World Wide Web, see Internet

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