MEDICARE

A Strategy for Quality Assurance

Volume I

Committee to Design a Strategy for Quality Review and Assurance in Medicare

Division of Health Care Services

INSTITUTE OF MEDICINE

Kathleen N.Lohr, editor

NATIONAL ACADEMY PRESS
Washington D.C.
1990



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OCR for page R1
Medicare: A Strategy for Quality Assurance - Volume I MEDICARE A Strategy for Quality Assurance Volume I Committee to Design a Strategy for Quality Review and Assurance in Medicare Division of Health Care Services INSTITUTE OF MEDICINE Kathleen N.Lohr, editor NATIONAL ACADEMY PRESS Washington D.C. 1990

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Medicare: A Strategy for Quality Assurance - Volume I National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competencies and with regard for appropriate balance. Volume I of this report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. This study was supported by the Health Care Financing Administration, U.S. Department of Health and Human Services, under Cooperative Agreement No. 17-C-99170/3. Library of Congress Cataloging-in-Publication Data Institute of Medicine (U.S.). Division of Health Care Services. Medicare: a strategy for quality assurance: a report of a study by a committee of the Institute of Medicine, Division of Health Care Services/Kathleen N.Lohr, editor. p. cm.—(Publication IOM; 90–02) “Committee to Design a Strategy for Quality Review and Assurance in Medicare”—P. following t.p. verso. “This study was supported by the Health Care Financing Administration, U.S. Dept. of Health and Human Services, under cooperative agreement no. 17-C-991/3”—T.p. verso. Includes bibliographical references. ISBN 0-309-04230-5 (v. 1) 1. Medical care—United States—Quality control. 2. Medicare. I. Lohr, Kathleen N., 1941–. II. Institute of Medicine (U.S.). Committee to Design a Strategy for Quality Review and Assurance in Medicare. III. United States. Health Care Financing Administration. IV. Title. V. Series: IOM publication; 90–02. [DNLM: 1. Health Insurance for Aged and Disabled, Title 18. 2. Quality Assurance, Health Care—United States. WT 30 I591m] RA395.A3I56 1990 362.1’0973–dc20 DNLM/DLC for Library of Congress 90–5787 CIP Copyright © 1990 by the National Academy of Sciences No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purpose of official use by the United States government. Printed in the United States of America

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Medicare: A Strategy for Quality Assurance - Volume I Committee to Design a Strategy for Quality Review and Assurance in Medicare STEVEN A.SCHROEDER,* Chair, Division of General Internal Medicine, University of California at San Francisco, San Francisco, California MARK R.CHASSIN, Value Health Sciences, Santa Monica, California (formerly of The RAND Corporation) LEO M.COONEY, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut ROBERT B.COPELAND,* Georgia Heart Clinic, LaGrange, Georgia CHARLES J.FAHEY,* Third Age Center, Fordham University, New York, New York PAUL F.GRINER,* University of Rochester Medical Center and Strong Memorial Hospital, Rochester, New York WILLIAM S.HOFFMAN, Social Security Department, International Union, United Auto Workers, Detroit, Michigan ROBERT L.KANE, School of Public Health, University of Minnesota, Minneapolis, Minnesota HAROLD S.LUFT,* Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California MAXWELL MEHLMAN, The Law-Medicine Center, Case Western Reserve University School of Law, Cleveland, Ohio MARIE MICHNICH, American College of Cardiology, Bethesda, Maryland MARILYN MOON, Public Policy Institute, American Association of Retired Persons, Washington, DC (until October 1989); The Urban Institute, Washington, DC JAMES D.MORTIMER, Midwest Business Group on Health, Chicago, Illinois ALBERT G.MULLEY, Jr., General Internal Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts EDWARD B.PERRIN,* Department of Health Services, University of Washington, Seattle, Washington MARGARET D.SOVIE,* Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania LORING W.WOOD, NYNEX Corporation, White Plains, New York *   Institute of Medicine Member

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Medicare: A Strategy for Quality Assurance - Volume I STUDY STAFF Division of Health Care Services KARL D.YORDY, Director KATHLEEN N.LOHR, Study Director MOLLA S.DONALDSON, Associate Study Director JO HARRIS-WEHLING, Staff Officer ALLISON J.WALKER, Research Associate MICHAEL G.H.McGEARY, Senior Staff Officer DONALD TILLER, Administrative Assistant THELMA COX, Secretary DENISE GRADY, Secretary THERESA NALLY, Secretary