LEADER 11474nam 2200709 a 450 001 9910953845803321 005 20251017110116.0 010 $a9786610203963 010 $a9781280203961 010 $a128020396X 010 $a9780309583091 010 $a0309583098 010 $a9780585084749 010 $a0585084742 035 $a(CKB)111004366659578 035 $a(SSID)ssj0000200605 035 $a(PQKBManifestationID)11168609 035 $a(PQKBTitleCode)TC0000200605 035 $a(PQKBWorkID)10220928 035 $a(PQKB)11668845 035 $a(MiAaPQ)EBC3376121 035 $a(Au-PeEL)EBL3376121 035 $a(CaPaEBR)ebr10055115 035 $a(OCoLC)923261285 035 $a(Perlego)4736230 035 $a(DNLM)708187 035 $a(BIP)1017292 035 $a(EXLCZ)99111004366659578 100 $a19901105d1991 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt 182 $cc 183 $acr 200 00$aMedicare--new directions in quality assurance $eproceedings of an invitational conference /$fby the Institute of Medicine, Division of Health Care Services ; Molla S. Donaldson, Jo Harris-Wehling, and Kathleen N. Lohr, editors 205 $a1st ed. 210 $aWashington, D.C. $cNational Academy Press$d1991 215 $aix, 207 p. $cill 300 $aBibliographic Level Mode of Issuance: Monograph 311 08$a9780309044295 311 08$a0309044294 320 $aIncludes bibliographical references. 327 $aMedicare -- 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 -- REFERENCES -- 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 -- INTRODUCTION -- REFERENCES -- 5 Organization- and System-Focused Quality Improvement: The Committee View -- QUALITY IMPROVEMENT AND OUTCOMES -- THE ROLE QUALITY IMPROVEMENT PLAYS -- REFERENCES -- 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. 327 $aContinuous 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 -- REFERENCES -- PART IV New Directions: Improved Decisionmaking by Patients and Clinicians -- New Directions: Improved Decisionmaking by Patients and Clinicians -- INTRODUCTION -- 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 -- SUMMARY -- REFERENCES -- 8 Improved Decisionmaking by Patients and Clinicians: A Response -- PATIENT PERSPECTIVES ON HEALTH CARE QUALITY -- INFORMATION NEEDS -- ISSUES CONCERNING PATIENT INFORMATION -- SUMMARY -- REFERENCES -- PART V New Directions: A Patient Outcomes Orientation -- New Directions: A Patient Outcomes Orientation -- INTRODUCTION -- 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 -- SUMMARY -- REFERENCES -- 10 A Patient Outcomes Orientation: A Response -- OUTCOMES OF CARE -- APPROPRIATENESS OF CARE -- PATIENT VALUES -- FUTURE ADVANCES IN DECISIONMAKING -- OUTCOMES RESEARCH -- QUALITY, RESOURCES, AND PRACTICE PATTERNS -- REFERENCES -- PART VI New Directions: Public Accountability and Program Evaluation -- New Directions: Public Accountability and Program Evaluation -- INTRODUCTION -- 11 Public Accountability and Program Evaluation: The Committee View -- BACKGROUND -- REFERENCES -- 12 Public Accountability and Program Evaluation: A Response -- NEED FOR CHANGES -- PROGRAM EVALUATION -- CONCLUDING REMARKS -- REFERENCE. 327 $aPART VII Confronting Special Implementation Issues -- Confronting Special Implementation Issues: -- INTRODUCTION -- REFERENCES -- 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 -- CONCLUSIONS -- REFERENCES -- 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 -- CONCLUSIONS -- REFERENCES -- 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 -- REFERENCES -- PART VIII New Directions: The Research, Training, and Capacity Building Agendas -- New Directions: The Research, Training, and Capacity Building Agendas -- INTRODUCTION -- 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. 327 $aREFERENCES -- 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 -- SUMMARY -- REFERENCES -- 18 The Training and Capacity Building Agendas: An Outside View -- PERSONNEL TRAINING -- CURRICULUM DEVELOPMENT -- RELATED TRAINING NEEDS -- PATIENT EDUCATION -- SUMMARY -- REFERENCES -- PART IX Response to the Institute of Medicine Report Recommendations -- Response to the Institute of Medicine Report Recommendations: -- INTRODUCTION -- REFERENCES -- 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 -- CLOSING REMARKS -- REFERENCE -- 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 -- REFERENCE -- 21 A Physician's Response to the Institute of Medicine Report -- CONCERNS ABOUT THE PROPOSED STRATEGY -- ECONOMIC ASPECTS OF QUALITY CONCERNS -- PROFESSIONALISM -- LEGAL ISSUES -- COST OF THE NEW PROGRAM -- SUMMARY -- REFERENCES -- 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 -- SUMMARY -- REFERENCE -- 23 An Administration Response to the Institute of Medicine Report from the Health Care Financing Administration. 327 $aPROBLEM 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 -- CONCLUDING REMARKS -- REFERENCE -- 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 -- SUMMARY -- REFERENCES -- PART X Where Do We Go From Here? -- Where Do We Go From Here? -- INTRODUCTION -- 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 -- SUMMARY -- REFERENCE -- 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 -- CONCLUDING REMARKS -- REFERENCES -- List of Authors. 330 $aThis 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. 606 $aMedicare$vCongresses 615 0$aMedicare 676 $a368.4/26/00973 701 $aDonaldson$b Molla S$01804686 701 $aHarris-Wehling$b Jo$f1941-$01814034 701 $aLohr$b Kathleen N.$f1941-$01806075 712 02$aInstitute of Medicine (U.S.).$bDivision of Health Care Services. 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910953845803321 996 $aMedicare--new directions in quality assurance$94367604 997 $aUNINA