Medicare New Directions in Quality Assurance Proceedings (1991) / Chapter Skim
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13. The Epidemiology of Quality Problems
13. The Epidemiology of Quality Problems
Pages 96-104
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From page 96... ...
In the Medicare Peer Review Organization (PRO) program it is detected primarily by the use of written criteria called "generic quality screens." Nurse reviewers read patients' records, using these criteria to identify adverse events occurring to patients.
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From page 97... ...
The committee found evidence of poor technical quality from several sources. These included reports of sanctions initiated by PROs against physicians or hospitals, reports of license withdrawals by state licensing boards, and reports of malpractice claim settlements.
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From page 98... ...
The California Medical Insurance Feasibility Study of 1977 showed that in 4.65 percent of hospital admissions, adverse events occur that are "potentially compensable" because they were caused in part by poor technical quality (Mills, 1977~. Adverse events occur most commonly with more complex procedures and with sicker patients.
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From page 99... ...
Poor implementation in turn harms patients and necessitates still more services to repair the damage; for instance, high rates of surgery bring with them an increased need to treat nosocomial infections. By doing many procedures and therefore having to do them in less well-prepared settings, problems with poor technical quality increase.
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From page 100... ...
A good outcome is likely, with or without the procedure. We can envisage, of course, even worse scenarios, such as when the patient is very sick and has a low probability of small benefit, so that a worse outcome is virtually certain from doing the procedure.
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From page 101... ...
For health care financed by third parties, however, some way must be found to incorporate societal values into the decision to do a procedure or provide another type of service, because societal resources are being consumed. For instance, whatever the net benefit to the patient, should scarce resources be used for a heart transplant on a 90-year-old patient?
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From page 102... ...
Using a carefully standardized process of peer review, the investigators identified all adverse events, that is, unintended injuries to patients caused by medical management, and all negligent adverse events, that is, those that result from failure on the part of the physician to provide reasonably careful management or to reach the standard of care. Because these data came from representative sampling, the investigators could generalize their findings to the total population of hospital patients in New York State.
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From page 103... ...
should become an active partner in promoting and facilitating continuous quality improvement among all physicians, nonphysician health professionals, and health care organizations. This is a change from an earlier mode of operation in which HCFA adopted a punitive and adversarial approach toward health care providers.
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From page 104... ...
Does Inappropriate Use Explain Small-Area Variations in the Use of Health Care Services? Journal of the American Medical Association 263:669-672, 1990.
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