Medicare New Directions in Quality Assurance Proceedings (1991) / Chapter Skim
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16. Research and Capacity Building: Issues Raised by the Institute of Medicine Report
16. Research and Capacity Building: Issues Raised by the Institute of Medicine Report
Pages 130-139
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From page 130... ...
report outlines in substantial detail the research agenda and questions concerning capacity building, so I will take this opportunity to give my perspective of the rationale behind these recommendations. My view is that this is not just the usual researchers' tag line at the end of the paper that reads "and more research is needed." From my perspective, it really arises from frank fear and terror concerning the implications of our larger agenda and the problems facing the national implementation of a quality assurance program.
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From page 131... ...
The question of generalizability, validity, reliability, and applicability to the real world of 5,000 or 6,000 hospitals, 400,000 physicians, and several million nurses and other health care practitioners has not been tested. It is a little bit scary to think about implementing a proposal based upon such a "thin" body of research.
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From page 132... ...
I suspect patient satisfaction directly affects patient outcomes, as well as being a separate measure that patients talk about.
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From page 133... ...
That is severity adjustment, even in the context of a randomized trial, and it could very well be that inconsistent results across various studies may in fact be a consequence of nonequivalence of the underlying populations. Health Status We need improved measures of health status and functional outcomes beyond dead or alive.
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From page 134... ...
How do we take the special circumstances of the medical care system with its substantial regulatory overlay licensing, for example, and certain publicly designed rules and regulations about how organizations and individuals are expected to behave and superimpose a continuous improvement model that by its very nature is saying, "Let's change the way we do some things? " A continuous improvement model might lead a hospital to decide that it is better to have nurses do certain things that physicians previously have been doing because, even though they are not licensed to do those things, they nontheless do them better.
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From page 135... ...
This means taking into account the problems of applying guidelines to clinically diverse patients, assuming that optical disks filled with specific indications down to the individual patient level are not a realistic option. If you cannot do that, then you must draw guidelines more broadly to account for wide variability in severity, indications, comorbidities, and similar factors.
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From page 136... ...
Health Maintenance Organizations Health maintenance organizations (HMOs) have often done quality assurance activities on their own, but one needs to take into account the different practice styles, different admission rates, and different kinds of settings in which HMOs deliver care.
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From page 137... ...
You, the health care professionals, need to figure out what the problem is and work it out." Rural Settings Rural health care has a set of unique problems partly because there are few providers. This factor causes access problems, about which we heard repeatedly, but it also causes problems for quality assurance.
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From page 138... ...
What should be the role of professional associations in encouraging careers in quality assessment and quality assurance? We need to identify a viable career path for people who really want to do quality assessment and assurance, rather than treating it as just a side issue done over a sandwich once a month as part of a medical staff commitment.
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From page 139... ...
Pp. 63-72 in Medicare: New Directions in Quality Assurance.
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