The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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6 Quality of Care
6 Quality of Care
Pages 126-134
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From page 126... ...
The larger context consists of an agenda of policies concerned with the application of prospective payment systems to sectors other than hospital care, modifications in Medicare and Medicaid benefits, and availability of staff, facilities, anct alternative sources of care, particularly for the Tong-term care patient. Policies that have been adopted, or are being contemplated, may 126
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From page 127... ...
The utility of information on quality of care for national policy purposes is directly related to the ability to examine relationships involving these variables. Selected policy questions relating to the quality of care, listed in order from issues that require research or evaluations to questions that depend on or are related to measurement of quality of care include: Should quality assurance mechanisms for health care services of the elderly be strengthened because of the adverse effects of cost containment?
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From page 128... ...
Outcome refers to changes in health status or maintenance of desirable levels of health influenced by health services; this includes one or more dimensions of physical and psychosocial functioning, disability, prevention of disease or complication of disease, satisfaction with health care, and mortality.
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From page 129... ...
Furthermore, the fact that standards are met does not provide assurance that a favorable effect on health status will follow. In short, structural factors such as the availability of highly qualified primary care providers, specialists and support services, or regionalized emergency medical service systems may increase the probability of receiving high-quality care, but they are not sufficient conditions for determining quality.
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From page 130... ...
This holds true for Al age groups, but it is particularly relevant for the elderly, whose neecis for health services are high and large proportions of whom could be affected positively or negatively. We specify outcome measures under the three functional goals of health care below: Caring involves reassurance and relief from anxiety, satisfaction, and communication between provider and patient, which may affect whether regimens prescribed are followed and response to symptoms and care-seeking are appropriate.
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From page 131... ...
However, the application of prevention procedures that are generally viewed as desirable would serve as an indicator of quality of care. These inclucle examination and follow-up of asymptomatic individuals for such conditions as hypertension, visual defects, impaired hearing, hypercholesteremia and counseling on smoking cessation, exercise, rest, diet, and rehabilitation aimed at restoring function consistent with the maximum achievable level.
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From page 132... ...
Another effect should be to intensify the development of severity of illness measures that are feasible for inclusion in data systems on hospital discharges (Horn and Horn, 1986~. Indicators of quality of care would become more readily available with the adoption of the Long-Term Health Care Minimum Data Set (U.S.
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From page 133... ...
The Long-Term Health Care Minimum Data Set (discussed in Chapter 7) , should be incorporated into relevant data systems.
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From page 134... ...
recognizes that most elderly are capable of responding for themselves when interviewed, but it is uncertain whether issues affecting the quality of information provided by them are similar or different from those at younger age groups e Interviewers encounter additional data quality problems in surveying the elderly because, with advancing age and for many in nursing homes, the number of cognitively impaired people increases and the interviewer is dependent on proxy respondents. The validity of data from proxies may be affected by many factors not well understood at this time.
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