Medicare -- 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.

Continuous 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.

PART 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.

REFERENCES -- 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.

PROBLEM 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.