A Comprehensive, National Quality
Assurance Strategy Is Needed

be scrutinized. For selected physicians in this category, on-site visits might be warranted to ensure that medical records are legible, integrated, and filed; that X-ray and laboratory equipment is properly calibrated, maintained, and used; and that the process of care (as revealed through a review of patients' records) is appropriate and high in quality.

Expanding access to care may bring some patients into the traditional
health care system for the first time. They will need assistance in learn-
ing to access the system appropriately, select primary care physicians,
and understand the importance of an ongoing relationship with an
"accountable" provider. Providers will need assistance in working with
these new patients and helping them to use the system wisely. All con-
sumers will need assistance in using the increasingly available informa-
tion on the appropriateness and quality of care to make prudent choices
among providers.

We believe that a comprehensive national quality assurance strategy is needed in order to ensure that all Americans receive high-quality medical care. A comprehensive national strategy is important for several reasons: (1) to ensure that the treatment of individuals does not depend on how the care is financed; (2) to be able to examine the contents, appropriateness, and outcomes of care, regardless of when and where the care was provided or who paid for it; and (3) to meet the legitimate needs for information on quality of the many different actors in the health care system.

We see four essential elements of a comprehensive national strategy:

national practice guidelines and standards of care,

enhanced data to support quality assurance activities,

improved approaches to quality assessment and assurance at the local level, and

a national focus for developing, implementing, and monitoring a national system.

We believe that the basic elements necessary to move toward a comprehensive national strategy currently exist. However, additional time and resources will be required to fully develop, implement, and evaluate the

A Comprehensive, National Quality
Assurance Strategy Is Needed

components that will make the system truly effective. The understanding and cooperation of health care providers, purchasers, consumers, and policymakers are also essential.

Expert Panel on Quality Assurance Issues

Robert Brook, M.D., Sc.D.

Deputy Director, Health Program
The Rand Corporation

John W. Bussman, M.D.

Medical Director

Oregon Medical Professional Review Organization

Robert Keller, M.D.

Executive Director

Maine Medical Assessment Foundation

Kathleen N. Lohr, Ph.D.

Senior Professional Associate

Institute of Medicine

National Academy of Sciences

Barbara Matula

Director

North Carolina Division of Medical Assistance

Michael R. McGarvey, M.D.

Corporate Vice President, Health Affairs

Empire Blue Cross and Blue Shield

Leslie Michelson

President and Chief Executive Officer

Value Health Sciences, Inc.

R. Heather Palmer, M.B., B.Ch., S.M.

Department of Health Policy and Management

Harvard School of Public Health

Gerald Plotkin, M.D.

Medical Director, Medical Groups Division

Harvard Community Health Plan

Cary Sennett, M.D., M. Phil.

Medical Director and Director of Technology Assessment
AETNA Life and Casualty

Expert Panel on Quality Assurance Issues

Michael Stocker, M.D.
Executive Vice President
U.S. Health Care

Leon Wyszewianski, Ph.D.

Department of Health Services Management and Policy The University of Michigan School of Public Health

Edward Zalta, M.D.

Chairman of the Board and Chief Executive Officer
Capp Care