Medicare--new directions in quality assurance : proceedings of an invitational conference / by the Institute of Medicine, Division of Health Care Services ; Molla S. Donaldson, Jo Harris-Wehling, and Kathleen N. Lohr, editors.

Format:

Book

Contributor:

Donaldson, Molla S.

Harris-Wehling, Jo, 1941-

Lohr, Kathleen N., 1941-

Institute of Medicine (U.S.). Division of Health Care Services.

Language:

English

Subjects (All):

Medicare--Congresses.

Medicare.

Physical Description:

ix, 207 p. : ill.

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1991.

Language Note:

English

Summary:

This book contains chapters and commentaries by members of the Institute of Medicine (IOM) committee and by outstanding practitioners, researchers, legislators, and policymakers about the IOM's proposals for new directions in quality assurance as specified in Medicare: A Strategy for Quality Assurance, Volumes 1 and 2. Sections of this new book address ideas about how to move toward increasing professionalism, implementing orgranization and system-focused quality improvement, better decision making by patients and clinicians, patient outcomes orientation, and public accountability and program evaluation. Other sections explore research questions and capacity building in the field of quality assessment and improvement, the epidemiology and quality problems, and legal issues in quality assessment.

Contents:

Medicare

Copyright

Acknowledgments

Contents

PART I Introduction

1 Introduction

QUALITY OF CARE AND QUALITY ASSURANCE FOR MEDICARE

THE INSTITUTE OF MEDICINE STUDY

THE INSTITUTE OF MEDICINE CONFERENCE ON MEDICARE: NEW DIRECTIONS IN QUALITY ASSURANCE

THE CONFERENCE AGENDA

2 The Institute of Medicine Report

CHARGES TO THE COMMITTEE

DEFINING QUALITY OF CARE

FINDINGS

Health Care and Health of the Elderly

Burden of Harm

Approaches to Quality Assurance

Peer Review Organizations

Capacity Building

A STRATEGY FOR MEDICARE QUALITY ASSURANCE

Mission and Goals of Medicare Program

Medicare Program to Assure Quality

REFERENCES

PART II New Directions: More Professionalism, Less Regulation

New Directions: More Professionalism, Less Regulation

INTRODUCTION

3 More Professionalism, Less Regulation: The Committee View

PROFESSIONALISM

RESPONSIVENESS TO OUTCOMES

COMPETITIVENESS

PRIDE

CONCLUSIONS

4 More Professionalism, Less Regulation: A Response

PROGRAMMATIC CONSIDERATIONS

PRACTICE PARAMETERS

AMERICAN MEDICAL ASSOCIATION (AMA) GUIDELINES FOR QUALITY ASSURANCE

RESEARCH AND PEER REVIEW

CONCLUSION

REFERENCE

PART III New Directions: Organization- and System-Focused Quality Improvement

New Directions: Organization- and System-Focused Quality Improvement

5 Organization- and System-Focused Quality Improvement: The Committee View

QUALITY IMPROVEMENT AND OUTCOMES

THE ROLE QUALITY IMPROVEMENT PLAYS

6 Organization- and System-Focused Quality Improvement: A Response

QUALITY IMPROVEMENT POLICY AT WEST PACES FERRY HOSPITAL

RELATING QUALITY ASSURANCE TO QUALITY IMPROVEMENT

THE INSTITUTE OF MEDICINE REPORT FROM A CONTINUOUS IMPROVEMENT PERSPECTIVE.

Continuous Improvement as a Preferred Model

The Power of Locally Developed Initiatives

Quality Improvement Education

Supportive Methods of Public Review and Oversight

Community Hospitals as Focal Points of Quality Improvement

SUMMARY

PART IV New Directions: Improved Decisionmaking by Patients and Clinicians

New Directions: Improved Decisionmaking by Patients and Clinicians

7 Improved Decisionmaking by Patients and Clinicians: The Committee View

FIRST-ORDER RESEARCH

APPLYING THE RESULTS OF EFFECTIVENESS RESEARCH TO PATIENT CARE

SHARED DECISIONMAKING

BARRIERS AND INCENTIVES TO IMPROVEMENT

8 Improved Decisionmaking by Patients and Clinicians: A Response

PATIENT PERSPECTIVES ON HEALTH CARE QUALITY

INFORMATION NEEDS

ISSUES CONCERNING PATIENT INFORMATION

PART V New Directions: A Patient Outcomes Orientation

New Directions: A Patient Outcomes Orientation

9 A Patient Outcomes Orientation: The Committee View

PROCESSES, OUTCOMES, AND PATIENT CHOICES

INFORMED DECISIONMAKING

CLINICAL PRACTICE AS A SOURCE OF KNOWLEDGE

PATIENT VALUES

OUTCOMES AND QUALITY ASSURANCE

10 A Patient Outcomes Orientation: A Response

OUTCOMES OF CARE

APPROPRIATENESS OF CARE

FUTURE ADVANCES IN DECISIONMAKING

OUTCOMES RESEARCH

QUALITY, RESOURCES, AND PRACTICE PATTERNS

PART VI New Directions: Public Accountability and Program Evaluation

New Directions: Public Accountability and Program Evaluation

11 Public Accountability and Program Evaluation: The Committee View

BACKGROUND

12 Public Accountability and Program Evaluation: A Response

NEED FOR CHANGES

PROGRAM EVALUATION

CONCLUDING REMARKS

REFERENCE.

PART VII Confronting Special Implementation Issues

Confronting Special Implementation Issues:

13 Confronting Special Implementation Issues: The Epidemiology of Quality Problems

THREE TYPES OF QUALITY PROBLEMS

Evidence of Quality Problems

The Overlap Between Overuse and Poor Technical Quality

Discouraging Overuse and Overcoming Underuse

Improving Technical Quality

14 Confronting Special Implementation Issues: Legal Concerns

MALPRACTICE

LEGAL INCENTIVES TO PERFORMANCE

Positive Inducements

Protection for Peer Review

Interventions and Sanctions

DUE PROCESS

Shifting Standards of Behavior

DATA PROTECTION AND RELEASE

15 Confronting Special Implementation Issues: Translating the Institute of Medicine Report Strategy Beyond Medicare

MAJOR THEMES OF THE INSTITUTE OF MEDICINE REPORT

Antecedent Processes and the Outputs of Health Care

Seven Derivative Themes

NEEDS OF HEALTH CARE ORGANIZATIONS

STRATEGIES FOR DIFFUSION

Gain Acceptance of Shared Responsibility

Remove Major Barriers

Develop and Disseminate Models

Enhancing Coordination

CLOSING REMARKS

PART VIII New Directions: The Research, Training, and Capacity Building Agendas

New Directions: The Research, Training, and Capacity Building Agendas

16 Research and Capacity Building: Issues Raised by the Institute of Medicine Report

VARIABILITY

PROCESS MEASURES

ART OF CARE

OUTCOMES

Severity Adjustment

Health Status

CONTINUOUS IMPROVEMENT

LINK BETWEEN PROCESS AND OUTCOME

PRACTICE GUIDELINES

SPECIAL SETTINGS

Ambulatory Care

Long-Term and Community-Based Care

Health Maintenance Organizations

Rural Settings

FINANCING

DIFFUSION

CAPACITY BUILDING

FUNDING.

REFERENCES

17 The Research Agenda: An Outside View

THE NEED FOR RESEARCH

JOINING BASIC AND APPLIED RESEARCH

STRUCTURE, PROCESS, AND OUTCOMES

GENERALIZABILITY

PATIENT AND PHYSICIAN PARTICIPATION

18 The Training and Capacity Building Agendas: An Outside View

PERSONNEL TRAINING

CURRICULUM DEVELOPMENT

RELATED TRAINING NEEDS

PATIENT EDUCATION

PART IX Response to the Institute of Medicine Report Recommendations

Response to the Institute of Medicine Report Recommendations:

19 A Legislator's Response to the Institute of Medicine Report

THE INSTITUTE OF MEDICINE REPORT

ADDRESSING PROBLEMS OF UNDERUSE

FUTURE DIRECTION OF HEALTH POLICY

ASSURING QUALITY OF CARE IN THE FUTURE

Insurance Reform

20 A Legislator's Response to the Institute of Medicine Report

ACCESS FOR MEDICARE ENROLLEES

A COMPREHENSIVE STRATEGY

CONCERN ABOUT COST CONTAINMENT AND MEDICARE

CONGRESSIONAL INTEREST

CONCERNS ABOUT PRACTICING PHYSICIANS

ADDITIONAL CONCERNS

CONGRESSIONAL RESPONSIBILITY

21 A Physician's Response to the Institute of Medicine Report

CONCERNS ABOUT THE PROPOSED STRATEGY

ECONOMIC ASPECTS OF QUALITY CONCERNS

LEGAL ISSUES

COST OF THE NEW PROGRAM

22 An Administration Response to the Institute of Medicine Report from the Agency for Health Care P ...

THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH

MEDICAL TREATMENT EFFECTIVENESS PROGRAM

QUALITY EVALUATION AND IMPROVEMENT INITIATIVE

MEDICAL LIABILITY PROGRAM

23 An Administration Response to the Institute of Medicine Report from the Health Care Financing Administration.

PROBLEM AREAS IDENTIFIED BY THE HEALTH CARE FINANCING ADMINISTRATION IN THE PAST

THE HEALTH CARE FINANCING ADMINISTRATION'S STRATEGY FOR PEER REVIEW

THE UNIFORM CLINICAL DATA SET ACTIVITY

OTHER ACTIVITIES SPONSORED BY THE HEALTH CARE FINANCING ADMINISTRATION

APPENDIX QUALITY ACTIVITIES OF THE HEALTH CARE FINANCING ADMINISTRATION

24 A Peer Review Organization Response to the Institute of Medicine Report

NEW DIRECTIONS SUPPORTED BY THE PRO COMMUNITY

CONTINUING NEED FOR RECORD REVIEW

PART X Where Do We Go From Here?

Where Do We Go From Here?

25 Where Do We Go From Here?

CURRENT MECHANISMS FOR ASSURING QUALITY CARE

Medical Education and Board Certification

Hospital Accreditation

COMMENTS ON THE INSTITUTE OF MEDICINE RECOMMENDATIONS

26 Where Do We Go From Here?

WHERE TO GO FROM HERE?

PATIENT OUTCOMES

EMPHASIZING PROFESSIONALISM

LONG-TERM STRATEGIES

RESEARCH, TRAINING, AND CAPACITY BUILDING

UTILITY OF THE STRATEGY

List of Authors.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references.

ISBN:

9786610203963

9781280203961

128020396X

9780309583091

0309583098

9780585084749

0585084742

OCLC:

923261285