NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competencies and with regard for appropriate balance.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.
This conference was supported by the Health Care Financing Administration, U.S. Department of Health and Human Services, under Cooperative Agreement No. 17-C-99170/3.
Library of Congress Catalog Card No. 90-63821
International Standard Book Number 0-309-04429-4
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COMMITTEE TO DESIGN A STRATEGY FOR QUALITY REVIEW AND ASSURANCE IN MEDICARE
STEVEN A. SCHROEDER, Chair, Chief,
Division of General Internal Medicine, University of California, San Francisco, California
MARK R. CHASSIN,
Value Health Sciences, Santa Monica, California
LEO M. COONEY, Jr.,
Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
ROBERT B. COPELAND,
Georgia Heart Clinic, LaGrange, Georgia
CHARLES J. FAHEY,
Third Age Center, Fordham University, New York, New York
PAUL F. GRINER,
University of Rochester Medical Center and Strong Memorial Hospital, Rochester, New York
WILLIAM S. HOFFMAN,
Social Security Department, International Union, United Auto Workers, Detroit, Michigan
ROBERT L. KANE,
School of Public Health, University of Minnesota, Minneapolis, Minnesota
HAROLD S. LUFT,
Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California
MAXWELL J. MEHLMAN,
The Law-Medicine Center, Case Western Reserve University School of Law, Cleveland, Ohio
MARIE MICHNICH,
American College of Cardiology, Bethesda, Maryland
MARILYN MOON,
Public Policy Institute, American Association of Retired Persons, Washington, D.C.
JAMES D. MORTIMER,
Midwest Business Group on Health, Chicago, Illinois
ALBERT G. MULLEY, Jr.,
General Internal Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts
EDWARD B. PERRIN,
Department of Health Services, University of Washington, Seattle, Washington
MARGARET D. SOVIE,
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
LORING W. WOOD, NYNEX
Corporation, White Plains, New York
STUDY STAFF
Division of Health Care Services
KARL D. YORDY, Director
KATHLEEN N. LOHR, Study Director
MOLLA S. DONALDSON, Associate Study Director
JO HARRIS-WEHLING, Staff Officer
ALLISON J. WALKER, Research Associate
H. DONALD TILLER, Administrative Assistant
THELMA COX, Senior Secretary
THERESA NALLY, Senior Secretary
Acknowledgments
The contributions of several members of the Institute of Medicine staff deserve special mention. Theresa Nally, Senior Secretary for the project, both assisted with the conference and prepared the manuscript. Thelma Cox, Project Secretary, H. Donald Tiller, Administrative Assistant, Allison J. Walker, Research Associate on the study, and Wallace K. Waterfall, Director of the Office of Communications, also provided valuable assistance. The consistent and generous support of Karl D. Yordy, Director of the Division of Health Care Services, deserves special mention.
Support for the study was provided by the U.S. Department of Health and Human Services, Health Care Financing Administration. We acknowledge the assistance of the government's project officer, Harry L. Savitt of the Office of Research and Demonstrations. The Institute of Medicine provided partial support for this monograph through its discretionary funds.
Contents
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Introduction |
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The Institute of Medicine Report |
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PART II: |
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The Committee View |
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A Response |
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PART III: |
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The Committee View |
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A Response |
PART IV: |
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The Committee View |
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A Response |
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PART V: |
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The Committee View |
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A Response |
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PART VI: |
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The Committee View |
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A Response |
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PART VII: |
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The Epidemiology of Quality Problems |
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Legal Concerns |
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Translating the Institute of Medicine Report Strategy Beyond Medicare |
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Part VIII: |
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Research and Capacity Building: Issues Raised by the Institute of Medicine Report |
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The Research Agenda: An Outside View |
The Training and Capacity Building Agendas: An Outside View |
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PART IX: |
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A Legislator's Response to the Institute of Medicine Report |
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A Legislator's Response to the Institute of Medicine Report |
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A Physician's Response to the Institute of Medicine Report |
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An Administration Response to the Institute of Medicine Report From the Agency for Health Care Policy and Research |
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An Administration Response to the Institute of Medicine Report From the Health Care Financing Administration |
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A Peer Review Organization Response to the Institute of Medicine Report |
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PART X: |
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Where Do We Go From Here? |
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Where Do We Go From Here? |