Medicare New Directions in Quality Assurance Proceedings (1991) / Chapter Skim
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9. The Committee View
9. The Committee View
Pages 63-72
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From page 63... ...
PROCESSES, OUTCOMES, AND PATIENT CHOICES The argument for more emphasis on outcomes is closely related to those for enhanced professional responsibility and patient involvement in decisionmaking. Simple building blocks can be used to demonstrate these relationships and then to broaden the argument to questions regarding the role of outcomes measurement in quality assurance.
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From page 64... ...
Symptoms that impair the quality of life prompt an encounter with the health care system. The box represents the structural elements those that relate to the capacity of the system to deliver quality health care.
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From page 65... ...
An intermediate outcome, such as impotence or incontinence following surgery, is also possible. The second alternative, watchful waiting, is less risky: the only possible outcomes are the most valued symptom relief— and the patient's current health state.
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From page 66... ...
We can learn something about the complexities of using outcomes for quality assurance by considering the methodological requirements of valid research. Information about patients entering the trial is systematically collected.
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From page 67... ...
The exclusions are important because different patients face different outcome probabilities even when the care rendered is identical. This is illustrated in Figure 9.3 by the three pairs of pie diagrams, each representing different outcome probabilities for a hypothetical patient.
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From page 68... ...
The committee felt, however, that probabilities alone were insufficient. Whether the pie diagrams in Figure 9.3 represent probabilities of outcomes for a health care decision or a simple game of roulette, information about the likelihood of the outcomes must be accompanied by information about their relative values in order to be helpful to the person making the decision.
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From page 69... ...
It is necessary information if we are to provide a context for the patient trying to make a health care decision, or if we are to measure quality using a definition that specifies desired health outcomes. The conceptual model is illustrated in Figure 9.5.
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From page 70... ...
OUTCOMES AND QUALITY ASSURANCE Clearly, this model assumes professional responsibility and patient involvement, elements of quality assurance that the IOM committee would like to promote. Yet what about quality assurance?
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From page 71... ...
Pp. 21-36 in Medicare: New Directions in Quality Assurance.
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From page 72... ...
Pp. 7-14 in Medicare: New Directions in Quality Assurance.
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