For the Public Good Highlights from the Institute of Medicine, 1970-1995 (1995) / Chapter Skim
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QUALITY OF CARE: A QUARTER-CENTURY OF WORK
QUALITY OF CARE: A QUARTER-CENTURY OF WORK
Pages 39-52
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From page 39... ...
. The chronicle below highlights selected IOM work in The author thanks Karl Yordy and Linda Demlo, both former directors of the Division of Health Care Services, for their assistance in providing background information on studies they carried out or supervised during their tenures; she also acknowledges the helpful comments of her IOM colleague Molla Donaldson, a senior program officer in the division.
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From page 40... ...
In 1982, the PSRO program was supplanted by the Utilization and Quality Control Peer Review Organization program, commonly known as the PRO program, which exists to this day. Within a short time, separate legislation created the Prospective Payment System for Medicare, which involved hospital reimbursement according to tThis account deals chiefly with IOM projects and studies.
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From page 41... ...
Stipulating desired health outcomes was especially important because it drew attention to a link between the processes of health care and outcomes of that care, to patient well-being and welfare, to the importance we should place on patients and their families being well informed about alternative health care interventions and their related expected outcomes, and to the need for health care professionals to take their patients' preferences and values into account. Finally, emphasizing current professional knowledge underscored the need for health professionals to stay abreast of a dynamic knowledge base in health care and to take responsibility for clarifying for their patients the processes and expected outcomes of care.
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From page 42... ...
asked the TOM to provide short-term, technical advice on its plans to evaluate the PRO program and, specifically, the emerging Health Care Quality Improvement Initiative activities. Recently HCFA has taken steps, based on the TOM work (published in ~ 994 as two brief reports entitled An Assessment of the HCFA Evaluation Plan for the Medicare Peer Review Organization Program)
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From page 43... ...
Moreover, the extraordinary rise in capabilities for generating, transmitting, storing, and analyzing health care data in the past two decades made such information more accessible to researchers, policymakers, and potentially journalists and the public. Thus, in 1992, the TOM began a study of the "potential that existing and emerging health database organizations offer in improving the health of individuals and the performance of the health care system," and it gave particular attention to public disclosure of quality-of-care information and to the protection of the confidentiality of personal health information.
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From page 44... ...
To carry out significant epidemiologic evaluations of care, for example, in the Washington, D.C., area, study staff developed methods for assessing measures such as hearing loss in children and, from them, generalizing to like areas of health services and inferring the level of overall care. The resulting reports, published in 1973-1974 under the series title Contrasts in Health Status, laid significant groundwork for empirical quality-of-care assessment that served well into the next decade; this was especially true of the second and third volumes-A Strategy for Evaluating Health Services and Assessment of Medical Care for Children.
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From page 45... ...
(Before the PSRO program was implemented, considerable effort had been devoted to prospectively developing an evaluation plan, and this study was part of that effort.) The study faced numerous tricky sampling, logistical, and confidentiality issues, because it investigated discharge abstracts processed by private abstract services and yet needed a nationally generalizable sample.
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From page 46... ...
The path to final federal regulations and implementation of the kinds of recommendations set forth in the nursing home regulation report, as translated into the Omnibus Budget Reconciliation Acts of 1987 and 1990, has been ex 46
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From page 47... ...
Care in nursing homes remains problematic in many ways, as documented in a recent TOM report (Real People, Real Problems: An Evaluation of the State Long-Term Care Ombudsman Program, 19944. Public concern about abuse and inferior quality of care in nursing facilities had led Congress to create the long-term-care ETCH ombudsman program in 1971 to enable ombudsmen to help resolve the problems faced by residents of LTC facilities while also advocating broad policy changes.
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From page 48... ...
, the TOM provided technical assistance, a definition of key terms in the 1989 legislation, and specifications of "critical attributes" of sound practice guidelines. The definition of gu~delines"systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances"-was immediately adopted by AHCPR (even before the report was released)
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From page 49... ...
The report provided a detailed provisional instrument for assessing practice guidelines that has subsequently been adapted for use both in the United States and overseas. In addition, it provided background for another study, done at AHCPR's request, on setting priorities for the selection of guidelines topics (~Setting Priorities for Clinical Practice Guidelines, 19954.
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From page 50... ...
in 1994, the TOM announced a special, Institute-w~de initiative: America's Health Care in Transition: Protecting and Improving Health and the Quality of Health Care. It is motivated by the recognition of the rapid and uncoordinated change occurring in the nation's health care system a penod characterized by increasingly constrained resources, decentralization of decision-making, consolidation of health care delivery plans and insurers, and new divisions of responsibilities among a wide range of health care professionals and organizations, both public and pnvate.
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From page 51... ...
Assessing Medical Technologies, 1985. An Assessment of the HCFA Evaluation Plan for the Medicare Peer Review OrganizationProgram, 1994.
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From page 52... ...
Reliability of National Hospital Discharge Survey Data, 1980. Setting Priorities for Clinical Practice Guidelines, Marilyn J
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