Medicare New Directions in Quality Assurance Proceedings (1991) / Chapter Skim
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15. Translating the Institute of Medicine Report
15. Translating the Institute of Medicine Report
Pages 116-126
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From page 116... ...
MAJOR THEMES OF THE INSTITUTE OF MEDICINE REPORT So my task is to concentrate on pursuit of the themes of the report not on the organizational form in which the pursuit will occur. Let me start by ~Editors' Note: The reference is to the proposed Medicare Quality Review Organizations, or MQROs, in the ION report.
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From page 117... ...
At the interface between these internal influences and the external world is the manner in which the results of clinical research are synthesized and disseminated to health care practitioners and then used to influence day-today practice. Here we are talking about the work of the research community in conducting and reporting clinical and health services research; the professional associations in their work efforts to develop and disseminate useful practice guidelines; and the educational community in its use of continuing education mechanisms.
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From page 118... ...
So rather than painting the quality scene as one in which external organizations tell hospitals and doctors what they have to do, and rather than these same outside agencies demanding a variety of data from health care organizations or from doctors and then making judgments about performance, the notion here is that we are all part of the problem and, thus, must all be part of its solution. The production of appropriate, efficient, and effective health care must become the combined effort of everyone represented in Figure 15.1.
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From page 119... ...
The same imperative exists for nurses, other health care practitioners, and managers of health care organizations. Quality assurance, as currently performed, simply does not make sense to most people involved in the day-to-day delivery of health care.
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From page 120... ...
They must also do more to bring order to the current cacophony of demands they make on health care organizations. Sixth, we must foster substantial enhancement in internal quality assurance and quality improvement mechanisms.
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From page 121... ...
S ROBERTS TABLE 15.2 Needs of Health Care Organizations 121 Models for the creation of a positive, improvement-oriented internal culture Synthesized state-of-the-art infonnation and models for, or indicators of, their use Practical models for process description, measurement, and improvement Public policy that more clearly differentiates "tail-of-the-curve" practice from the more universal need for continual improvement Coherent and coordinated external expectations and improvement-focused use of information day within a growing number of enlightened health care organizations.
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From page 122... ...
How would the new mindset change the data demands that accreditors, that government, and that businesses are expecting of health care organizations? What would it do to quality assurance requirements?
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From page 123... ...
It would be instructive to compare this list with the research agendas of the Agency for Health Care Policy and Research, the Joint Commission, and individual health services research centers to examine how well they match. Does this research answer these needs?
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From page 124... ...
TABLE 15.5 Develop and Disseminate Models Health care organizations are starving for models The need is for approaches that have received real-world testing There are activities under way in all areas of necessary change · Both successes and failures must be made known . This is not always the material sought by refereed journals Enhancing Coordination Finally, it is important that we enhance coordination among external actors, such as government agencies, PROs, accreditors, insurers, and the long list of other folks that are external to health care organizations (Table 15.61.
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From page 125... ...
If government and professional leaders are prevented by these destructive stereotypes from exploring more rational, integrative, 2Editors' Note: The reference is to the opening recommendation of the IOM committee, which states: Congress should expand the mission of Medicare to include an explicit responsibility for assuring the quality of care for Medicare enrollees, where quality of care is defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
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From page 126... ...
Institute of Medicine. Medicare: A Strategy for Quality Assurance.
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