Assessing Health Care Reform (1993) / Chapter Skim
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Assuring the Quality of Care
Assuring the Quality of Care
Pages 33-44
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From page 33... ...
Reform plans can achieve these objectives only win explicit attention to quality, which includes defining, measuring, assuring, and improving the quality of care. Therefore, the committee proposes a set of quality-related principles and policies for health care reform proposals and advances an argument for greater attention to clinical practice guidelines.
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From page 34... ...
In considering such outcomes, reform proposals should provide for the use of a wide range of health-reiated quality of life measures; the alTay of tasks that Blight requnre such measures includes determining core benefits, assessing the effectiveness of health care technologies, and monitoring and improving the quality of care over time TOM, 1989c,f, 199Oa,b,f,g,h; Lohr, 1989, 1992~. The focus should not be on just the effect of health care on survive and life expectancy or various symptom, physiologic, and biologic states.
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From page 35... ...
These mvolve Be physical environment In which we live and work, the economic environment In which we labor, Me skills we bring to coping with life's challenges, and We ethical, moral, and spiritual aspects of our lives. These factors, In many respects, are less appropriate as measures of health care outcomes than as masticators of circumstances Cat may limit or reinforce the impact of medical care.
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From page 36... ...
. It states that the program should: address poor technical or interpersonal quality, overuse of unnecessary or inappropriate services, and underuse of needed services; intrude only minimally into the p~ient-cl~n~cian relationship; be acceptable to health care professionals and provider organizations; foster improvement throughout the health care organization and system; identify and intervene to remedy demonstrably substandard performance (the so called outlier or bad apples problem)
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From page 37... ...
These are, nonetheless, the characteristics of a successful quality assurance and quality improvement effort toward which the system ought to move, even as reform plans are being put into effect. Individual and System Perspectives Third, Be committee draws attention to Me different perspectives Cat health care reform proposals need to reflect.
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From page 38... ...
Roles and Responsibilities Fourth, health care reform proposals must be clear about organizational structur - , procedures, and divisions of responsibility and make explicit provisions for both internal and external monitoring of quality of care. Specifically, they should set in place conditions that will help health organizations, provider groups, and practitioners act on their own to measure and improve quality.
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From page 39... ...
Practice guidelines are in a relatively embryonic state of development, especially insofar as cost containment, design of basic benefit packages, and ocher endeavors key to health care reform are concerned. Thus, as the committee has already suggested in its discussions of access and cost containment, health care reform proposals should not place more burdens on guidelines for solving problems of cost control, benefit package design, rationing, competition, administration, or quality Can they, at their present stage of development' can sustain.
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From page 40... ...
by determining priorities for Improving or standardizing specific patterns of clinical care and sorting out competing claims for funding of biomedical and outcomes or effectiveness research. With respect to cost management, proposals can also recognize that Pose who pay for health care services and their agents can use guidelines in various ways, including (~)
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From page 41... ...
The committee recommends that reform proposals mandate that a quality assurance and improvement program track the effects of certain cost containment processes. This charge includes monitoring the impact of geographic global budgets and caps, if such are proposed.
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From page 42... ...
These problems demand timely attention and resolution. Thus, the committee recommends that health care reform proposals mandate an additional responsibility of a quality assurance and improvement program namely, to serve as a focus for consumer complaints or as an ombudsman.
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From page 43... ...
Reform proposals will need to reflect both concern with the quality of care provided by individual plans and practitioners and attention to the quality of care across the entire system. Health care reform proposals should be clear about organizational structures, procedures, and divisions of responsibility and make explicit provisions for bow internal and external monitoring of quality of care.
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From page 44... ...
A formal, nonjudicial mechanism by which individuals can voice grievances and obtain assistance should be available to all as the nation moves through the next few years of experimentation and change. This committee recommends that health care reform proposes mandate an additional responsibility of a quality assurance and improvement program—namely, to serve as a focus for consumer complaints or as an ombudsman.
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