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CONTENTS Introduction and Summary Summary of Major Conclusions and Recommendations The Context of the Conclusions Historical Development of Regulation of the Quality of Health Care TI The Principles of Quality Assurance Scope Jurisdiction Population base Providers to be included Inclusion of ambulatory care Methods and Data Requirements Methods Type of data to be collected Methods for collecting data Criteria for the application of data Structural, process, and outcome data Data source, costs, and reliability Specific methods in quality assessment Recommendations about methods Summary of conclusions about methods Data Requirements Kinds of data Uniformity of data Methods for collecting and retrieving data Compatibility of all health care data Confidentiality of patient data The patient's medical record Standards The Costs of Quality Assurance Quality Assurance Costs Costs of Establishing Quality Assurance Systems The Costs of Maintenance The Overall Costs of Health Care 1 4 5 7 7 7 9 10 11 11 12 12 12 15 16 17 18 19 21 22 23 24 25 26 27 27 28 29 30 30 31 31
Improving Performance: Education and Sanctions 32 Management and Control 34 Expertise: review level 35 Expertise: supervisory level 36 Control 36 Management 36 Research, Development and Evaluation 40 ITI The Future of Quality Assurance 43 Anticipating the Unexpected 43 Standards and costs Administrative probe ems The patient's responsibility Physician distribution Effects Pitfalls of technology Health maintenance organizations (HMOs) and quality assurance What Can We Hope For? 43 44 44 44 44 45 45 IV The Implications of the Principles for the PSRO Program 47 Comment and Dissen Bibliography at 1V 53 55
