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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH
Agency forHealthCarePolicy andResearch
The Agency for Health Care Policy and Research (AHCPR), a U.S. Department of Health and Human Services agency, was established in 1989 with a Congressional mandate to generate and disseminate information that would be useful to consumers, practitioners, and other audiences. The majority of AHCPR's activities are aimed at improving the quality of health care. Accordingly, the agency works with several organizations, including the Foundation for Accountability, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the American Medical Association, to help to provide a science base for quality measurement, and to assist in translating research findings to quality measures.
Through its Center for Quality Measurement and Improvement, AHCPR conducts and supports research on the measurement and improvement of the quality of health care, including consumer surveys and satisfaction with health care services and systems. The agency has produced and disseminated clinical practice guidelines in a variety of formats to meet the needs of health care practitioners, the scientific community, educators, and consumers. A clinical practice guideline on the detection, diagnosis, and treatment of depression was released in 1993.
AHCPR sponsors a Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST), a prototype system for collecting and evaluating clinical performance measures. The system includes two linked data bases, one on conditions and one on measures, to help clinicians, providers, managed care organizations, and purchasers find clinical performance measures that match their needs. Information is included on approximately 1,200 measures developed by public-and private-sector organizations. Among these are measures for the following conditions: affective disorder, alcohol abuse, bipolar disorder, depression, drug abuse, dysthymic disorder, panic disorder, suicidal ideation, and suicide (mortality).
AHCPR has supported research on the implementation of guidelines in a variety of settings, including HMOs and group practice, and examining a variety of strategies, including incentives and individualized feedback. Other areas of AHCPR-supported research include factors that affect costs, premiums, and choice of health plans; clinical and effectiveness research in HMOs; and managed care in rural areas.
Ideally, accreditation is a process that surveys health care delivery organizations to determine whether the services provided have met a set of recognized standards for that domain. During the last ten years, accreditation has become an important vehicle to review and monitor the inner structure of organizations that deliver health care. As discussed in other parts of this report, a growing trend