Health Care Quality Improvement Program

Quality-based Medicare provider payment As concerns over the costs and the quality of the health care for Medicare beneficiaries grew, in 1992, the CMS developed a new program for assessing quality, the Health Care Quality Improvement Program (HCQIP). The HCQlP s aims are to ... 

Cleves MA, Weiner JR, Cohen W, Athon C, Banks N, Boress L et al. Assessing HCFA s health care quality improvement program. ]t. Comm. ]. Qual. Improv. 1997 23 550-560. 

Most QI programs build upon an established quality assurance (QA) process. Quality assurance can be defined as a formal and systematic process in which problems in delivering health care are identified, solutions to the problems are developed and implemented, and follow-up monitoring then is carried out [30]. QA begins with problem identification. After possible sources of the problem are determined, solutions are developed and implemented. Then, the results of the intervention or solution are evaluated to determine whether or not the problem has been resolved. By incorporating a goal of continual improvement, a QA process can contribute to quality improvement activities. 

MedWatch program. The FDA recently established the Special Nutritionals Adverse Event Monitoring System, a searchable database including information about suspected adverse events associated with dietary supplements or nutritional products. This database includes reports that have been submitted to MedWatch and can be accessed via the Internet (http //vm.cfsan.fda.gov/ dms/ aems.html). Continued efforts by health-care professionals to recognize and report suspected interactions between prescription medications and herbal and other alternative therapies should ultimately increase knowledge and awareness of interactions and improve the quality of patient care (see Heck et al., 2000 Izzo, 2004 Butterweck, 2004 Chan, 2005). 

In the future, the accreditation process may become more focused on outcomes measurement. Eventually, health care report cards may be more accessible and easy to understand, thus helping to produce a market for quality. Some discussion of adjusting copayments to encourage patients to use providers that meet the standards purchasers have set has already occurred (Lovern, 2001). In some cases, pharmacy quality improvement may be mandated by state and local governments. For example, a new law in the state of Arizona requires that every pharmacy participate in a CQI program (Arizona Revised Statutes, 2007). 

To enhance the quality, appropriateness, and effectiveness of health care services, and access to these services the federal government in the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239) established the AHCPR. The act, sometimes referred to as the Patient Outcome Research Act, called for the establishment of a broad-based, patient-centered outcomes research program. In addition to the traditional measures of survival, clinical endpoints and disease- and treatment-specific symptoms and problems, the law mandated measures of functional status and well-being and patient satisfaction. In 1999, then President Clinton signed the Healthcare Research and Quality Act, reauthorizing AHCPR as the AHRQ until the end of fiscal year 2005. Presently, its mission is to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, broaden access to effective services, and improve the quality of health care services. 

Pharmaceutical outcome data are also used to improve the quality of care, identify potential problems, and improve patient outcomes. These data are often used within a continuous quality improvement (CQI) cycle, where rate-based performance measures are tracked over time and used in conjunction with control charts to show changes in quality and assess the impact of programs or changes in process. Information can be fed back to front line health care practitioners, areas for possible improvement identified, appropriate changes made, and reassessments initiated. 

Works with other health care providers and relevant committees to develop programs for improving drug use and quality of patient care. 

Utilization Review Accreditation Commission (URAC) a Washington-based, not-for-profit corporation formed in 1990 and dedicated to improving the quality of utilization review in the health care industry by providing a method of evaluation and accreditation of utilization review programs. 

Ovretveit, J. and Staines, A. (2007) Sustained improvement Findings from an independent case study of the Jonkoping quality program. Quality Management in Health Care, 16(1), 68-83. 

Davis, K., and others. Room for Improvement Patients Report on the Quality of Their Health Care. New York The Commonwealth Fund, 2002. [http //www.cmwf.org/programs/quality/ davis improvement 534.pdf]... 

Workplace. Since the 1970 s, the numbers of organizations offering fitness centers at their work sites has increased. Employees can more easily fit exercise into their workday at a facility that is convenient and often competitively priced. By offering group classes and quality supervision in the weight rooms, a company can be assured that its employees can exercise safely and obtain the health benefits. Workplace health programs have been shown to reduce health care costs and absenteeism and to improve productivity. 

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