HCFA's health care quality improvement program: the medical informatics challenge.
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The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries. (+info)
Validity review of performance measures.
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A structured process for evaluating the validity of performance measures is essential if the rates generated by these measures are to be relied upon for large-scale programmes to improve clinical care. In this evaluation process a panel of objective clinicians who were not involved in developing the performance measures examines the criteria, coding instructions, and coding form. The panel's job is to determine the degree to which a sample of patient records containing treatment elements that have been flagged for nonconformance to certain criteria are truly nonconformant. Modification of the performance measure according to the recommendations of the panel provides an important means of reducing measurement error by eliminating obvious sources of false positive findings. This article describes the procedures followed and the materials used to validate the performance measures developed for the project to Develop and Evaluate Methods for Promoting Ambulatory Care Quality (DEMPAQ), a research project contracted by the Health Care Financing Administration of the United States government [1-3]. DEMPAQ is described in Fig. 1. In the DEMPAQ project, record review is conducted by entering data directly from patient ambulatory records into a computer system. Instructions for abstracting the data are displayed on the computer monitor. (+info)
Medical audit, continuing medical education and quality assurance.
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Medical audit and continuing medical education (CME) are now the mainstays of quality assurance in hospitals. Audits should address problems that have serious consequences for patients if proper treatment is not given. The single most important step is the selection of essential or scientific criteria that relate process to outcomes. CME does less than commonly believed to improve care. Today, quality assurance increasingly means a near-guarantee to every patient of appropriate treatment and fewest possible complications. Maintenance of the public trust rests on a firm commitment of the medical staff and board to this principle, implemented through an organized program of quality assurance. Under these conditions, medical audit and CME can effectively improve care by improving physician performance. (+info)