Quality Assurance: A Comprehensive National Strategy for Health Care is Needed : Briefing Report to the Chairman, United States Bipartisan Commission on Comprehensive Health Care

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Page 13 - When one is clear and constant in one's purpose, when fear does not control the atmosphere (and thus the data), when learning is guided by accurate information and sound rules of inference, when suppliers of services remain in dialogue with those who depend on them, and when the hearts and talents of all workers are enlisted in the pursuit of better ways, the potential for improvement in quality is nearly boundless.
Page 23 - Feb. 1990). GAO addressed the following four elements viewed essential to a comprehensive national strategy: (1) national practice guidelines and standards of care; (2) enhanced data to support quality assurance activities; (3) improved approaches to quality assessment and assurance at the local level; and (4) a national focus for developing, implementing, and monitoring a national system. Laboratory Accreditation: Requirements Vary Throughout the Federal Government (GAO/RCED-89-102, Mar.
Page 15 - Director, using the process set forth in section 913, shall arrange for the development and periodic review and updating of — (1) clinically relevant guidelines that may be used by physicians, educators, and health care practitioners to assist in determining how diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically...
Page 13 - Real improvement in quality depends, according to the Theory of Continuous Improvement, on understanding and revising the production processes on the basis of data about the processes themselves. "Every process produces information on the basis of which the process can be improved,
Page 17 - Law 101-239, established the Agency for Health Care Policy and Research within the Public Health Service to promulgate guidelines and standards of quality and other "performance measures.
Page 8 - ... with developmental disabilities: Quality assurance systems typically concentrate on quality assessment and the identification of the relatively small number of providers whose care is obviously unacceptable. They do comparatively little in attempting to directly improve the overall levels of quality provided by the majority of health professionals. . . . If we think of performance of health care providers in terms of the bell-shaped curve of a normal distribution, the challenge is to devise a...
Page 16 - However, some of the estimates fail to account for the potential cost of alternative treatments that might be provided in place of procedures found to be inappropriate and the likelihood that a program intended to reduce inappropriate care would never be fully successful.
Page 13 - Second, health considerations dictate a comprehensive approach. Meeting the health care needs of individuals frequently requires providing care in a variety of settings (that is, hospitals, physicians' offices, nursing homes, home health agencies, and so on) over an extended period of time. What occurs in one setting or at one time is often influenced by what occurred in a different setting at a different point in time.
Page 7 - Quality Assessment Should Be Distinguished From Quality Assurance It is important to distinguish between quality assessment and quality assurance. Quality assessment involves the use of measures of quality, based on either explicit or implicit criteria, to assess the structure, process, and outcome of care and to monitor levels of quality over time. Quality assurance goes beyond the simple assessment of quality to include its improvement. This requires identifying and confirming problems in the quality...
Page 17 - An enhanced data base would enable monitoring the quality of care provided to individual patients across health care settings and providers. For example, evaluating the outcome of a surgical intervention requires knowing what happened to the patient after he or she left the hospital. An enhanced data base would also allow for the profiling of individual provider practice patterns based on care paid for by all purchasers rather than a single purchaser.

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