• Accuracy of conditions households could report

  • Availability of evidence-based quality measures

  • Burden to society in terms of expenditures

Using these criteria, the following medical conditions were targeted by the MEPS healthcare quality enhancement effort: diabetes, asthma, hypertension, ischemic heart disease, arthritis, stroke, and chronic obstructive pulmonary disease.

Veterans Administration (VA): Quality Enhancement Research Initiative (QUERI)

QUERI is an integrated quality improvement program in use at the VA. QUERI’S underlying goals are to identify best practices, to incorporate them into daily use, and to provide a feedback mechanism to ensure continuous quality improvement. QUERI functions to translate findings in the research setting into improved patient care and system redesign (Demakis et al., 2000; Feussner et al., 2000; Kizer et al., 2000). A six-step process is employed to ensure systematic adherence to quality improvement efforts:

  1. Identify high-risk/volume diseases among veterans.

  2. Identify best practices.

  3. Define existing practice patterns and outcomes across the VA and current variation from best practices.

  4. Identify and implement interventions to promote best practices.

  5. Document that best practices improve outcomes.

  6. Document that outcomes are associated with improved health-related quality of life.

Eight targeted conditions were selected as the focal point for QUERI: chronic heart failure, diabetes, HIV/AIDS, ischemic heart disease, mental health (depression and schizophrenia), spinal chord injury, and stroke. Criteria used to determine this group of conditions included the number of veterans affected, the burden of illness, and known health risks within the veteran population.

The Bureau of Primary Health Care/ Health Resources and Services Administration (HRSA/BPHC) Health Disparities Collaboratives

BPHC, part of HRSA within the Department of Health and Human Services (DHHS), provides funding for programs that expand access to high-quality, culturally and linguistically competent health care—both primary and preventive—for underserved, uninsured, and underinsured Americans. In 1998, BPHC organized five regional clusters of states and then funded one primary care association/clinical network team in each of these five clusters, along with the national clinical networks focused on oral health, migrant farm worker health care, and homeless health care (Health Disparities Collaboratives, 2002). These organizations then worked with the Institute for Healthcare Improvement (IHI) to develop the infrastructure for the Health Disparities Collaboratives.

The intent of these Collaboratives is to change primary health care practices in order to improve the care provided to everyone and eliminate health disparities. To meet this goal, it was determined that the Collaboratives should focus on a subgroup of the entire population and then, if successful, spread to the rest of the patients in a community.

The first collaborative, initiated in January 2000, focused on diabetes; it was quickly followed by the asthma and depression collaborative in March 2000. The program then expanded to cardiovascular disease in April 2001: future Collaboratives are expected to include cancer, prevention, infant mortality, and immunizations (Health Disparities Collaboratives, 2002; Stevens, 2002).

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