Medicare's quality improvement organization program: maximizing potential
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Washington, D.C.
National Acad. Press
2006
|
| Schriftenreihe: | Pathways to quality health care
|
| Schlagworte: | |
| Online-Zugang: | http://www.nap.edu/catalog/11604.html Table of contents Inhaltsverzeichnis |
| Beschreibung: | "This study was supported by Contract No. HHSM-500-2004-00010C between the National Academy of Sciences and the United States Department of Health and Human Services through the Centers for Medicare and Medicaid Services"--T.p. verso. Includes bibliographical references and index -- Also issued online. |
| Beschreibung: | XXI, 518 S. graph. Darst. |
| ISBN: | 0309101085 |
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| 500 | |a Includes bibliographical references and index -- Also issued online. | ||
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| 650 | 4 | |a Medical care |z United States |x Quality control | |
| 650 | 4 | |a Health care reform |z United States | |
| 650 | 4 | |a Medicare |x organization & administration | |
| 650 | 4 | |a Quality Assurance, Health Care |x organization & administration |z United States | |
| 650 | 4 | |a Health Care Reform |x organization & administration |z United States | |
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Datensatz im Suchindex
| _version_ | 1804138311822868480 |
|---|---|
| adam_text | Contents
SUMMARY
1
Background,
2
Key Findings and Conclusions,
4
Recommendations,
11
INTRODUCTION
19
Background,
20
Audiences for This Report,
27
Study Approach,
27
Organization of This Report,
29
References,
30
INTRODUCTION TO PART I
33
1
A HISTORICAL PERSPECTIVE AND THE CURRENT
QIO PROGRAM 35
History of the QIO Program,
36
Evolution of Medicare s Quality Improvement Program,
39
Summary,
52
References,
53
2
ASSESSMENT OF THE QIO PROGRAM:
FINDINGS AND CONCLUSIONS
55
Evidence of Quality Improvement in Medicare,
56
Alternatives to the Current QIO Program,
61
XVII
xviii CONTENTS
Program
Infrastructure,
63
Functions of the QIOs,
66
Structural Issues,
69
Oversight of the QIO Program,
74
Summary,
79
References,
79
3
PERFORMANCE MEASUREMENT, QUALITY
IMPROVEMENT, AND OTHER ENTITIES
82
The Need for an Organized Performance Measurement and
Reporting System,
83
Functions of the National Quality Coordination Board and
Implications for QIOs,
90
References,
101
4
IMPROVING QUALITY AND PERFORMANCE
MEASUREMENT BY THE QIO PROGRAM
102
Technical Assistance Functions,
105
QIO Support for Quality Improvement Efforts,
109
QIO Board and Organizational Structure,
110
Responsibility for Complaints, Appeals, and Case Reviews,
112
References,
118
5
CMS OVERSIGHT OF THE OPERATIONS AND
MANAGEMENT OF THE QIO PROGRAM
120
Data Processing,
121
QIO Program Management,
126
QIO Program Evaluations,
134
QIO Program Funding,
138
References,
141
INTRODUCTION TO PART II
143
6
STUDY APPROACH
145
Data Sources,
146
Focused Literature Review,
148
Web-Based Data Collection,
149
Quantitative Analyses of QIO Performance,
150
Visits to QIOs,
151
Telephone Interviews,
151
Three-Day Briefing by CMS,
154
Access to QIONet,
154
Face-to-Face Interviews,
155
CONTENTS xix
Focus
Group, 155
Specific
Data
Requests to CMS Staff,
156
Formal and Informal Discussions with AHQA,
156
Informal Discussions with Consumer Organizations and
Providers,
156
National Conferences and Meetings,
157
Suggestions of Other Entities,
157
Research Challenges,
157
Strength of Research Conclusions,
158
References,
159
7
STRUCTURE AND FINANCES
160
Structure of QIOs,
160
QIO Support Centers,
173
Finances of QIOs,
179
Summary,
188
References,
190
8
TECHNICAL ASSISTANCE FOR QUALITY
IMPROVEMENT
192
Defining Technical Assistance,
193
Recruitment of Identified Participants,
193
Interaction with Providers,
197
Technical Assistance During the 7th and 8th SOWs,
199
Nursing Homes,
201
Home Health,
205
Hospitals,
208
Physicians Offices and Practices,
213
Underserved and Rural Beneficiaries,
218
Managed Care,
221
QIO Support Centers,
223
Summary,
227
References,
228
9
IMPACT OF TECHNICAL ASSISTANCE FOR QUALITY
IMPROVEMENT AND KNOWLEDGE TRANSFER
230
Quality Improvement,
230
Approaches to Quality Improvement,
239
Knowledge Transfer,
243
Summary,
252
References,
252
xx
CONTENTS
10 EVALUATION
OF QUALITY IMPROVEMENT
ACHIEVED BY THE QIO PROGRAM
257
CMS Evaluation of QIO Performance on Technical
Assistance Tasks,
257
IOM Analysis of Task
1
Performance by QIOs,
262
Impact of Intense QIO Assistance,
272
Provider Satisfaction,
273
Programwide Evaluation of Impact,
276
Summary,
277
References,
278
11
BENEFICIARY EDUCATION AND COMMUNICATIONS
279
Task 2a: Promoting the Use of Performance Data,
279
Task 2b: Transitioning to Hospital-Generated Data,
285
Task 2c: Other Mandated Communications Activities,
287
Role of QIOs in Beneficiary Education: Telephone Interviews,
288
QIO Support Centers in the 7th and 8th SOWs,
293
Summary,
295
References,
295
12
PROTECTION OF MEDICARE BENEFICIARIES AND
PROGRAM INTEGRITY
297
Case Review Activities in the 7th SOW,
298
Mediation in the 7th SOW,
307
Medicare Beneficiary Protection QIOSC,
308
QIO Performance Evaluation in the 7th SOW,
310
Case Review Activities in the 8th SOW,
310
Hospital Payment Monitoring Program in the 7th SOW,
311
HPMP in the 8th SOW,
315
Impact of Protective Activities in the 7th SOW,
318
Summary,
322
References,
323
13
CMS OVERSIGHT
325
Organizational Structure of QIO Program in CMS,
325
Communications and Information Technology Services,
333
Data Flow,
341
Data Lag Issues,
343
QIO Contracts,
345
Overall Program Guidance,
351
Summary,
358
References,
359
CONTENTS xxi
APPENDIXES
A SUPPORTING TABLES
363
В
PRIVATE-SECTOR ORGANIZATIONS OFFERING
SERVICES RELATED TO QUALITY IMPROVEMENT
435
С
APPROACHES TO EVALUATION DESIGN
466
D
GLOSSARY AND ACRONYMS
473
E
COMMITTEE BIOGRAPHIES
481
INDEX
501
|
| adam_txt |
Contents
SUMMARY
1
Background,
2
Key Findings and Conclusions,
4
Recommendations,
11
INTRODUCTION
19
Background,
20
Audiences for This Report,
27
Study Approach,
27
Organization of This Report,
29
References,
30
INTRODUCTION TO PART I
33
1
A HISTORICAL PERSPECTIVE AND THE CURRENT
QIO PROGRAM 35
History of the QIO Program,
36
Evolution of Medicare's Quality Improvement Program,
39
Summary,
52
References,
53
2
ASSESSMENT OF THE QIO PROGRAM:
FINDINGS AND CONCLUSIONS
55
Evidence of Quality Improvement in Medicare,
56
Alternatives to the Current QIO Program,
61
XVII
xviii CONTENTS
Program
Infrastructure,
63
Functions of the QIOs,
66
Structural Issues,
69
Oversight of the QIO Program,
74
Summary,
79
References,
79
3
PERFORMANCE MEASUREMENT, QUALITY
IMPROVEMENT, AND OTHER ENTITIES
82
The Need for an Organized Performance Measurement and
Reporting System,
83
Functions of the National Quality Coordination Board and
Implications for QIOs,
90
References,
101
4
IMPROVING QUALITY AND PERFORMANCE
MEASUREMENT BY THE QIO PROGRAM
102
Technical Assistance Functions,
105
QIO Support for Quality Improvement Efforts,
109
QIO Board and Organizational Structure,
110
Responsibility for Complaints, Appeals, and Case Reviews,
112
References,
118
5
CMS OVERSIGHT OF THE OPERATIONS AND
MANAGEMENT OF THE QIO PROGRAM
120
Data Processing,
121
QIO Program Management,
126
QIO Program Evaluations,
134
QIO Program Funding,
138
References,
141
INTRODUCTION TO PART II
143
6
STUDY APPROACH
145
Data Sources,
146
Focused Literature Review,
148
Web-Based Data Collection,
149
Quantitative Analyses of QIO Performance,
150
Visits to QIOs,
151
Telephone Interviews,
151
Three-Day Briefing by CMS,
154
Access to QIONet,
154
Face-to-Face Interviews,
155
CONTENTS xix
Focus
Group, 155
Specific
Data
Requests to CMS Staff,
156
Formal and Informal Discussions with AHQA,
156
Informal Discussions with Consumer Organizations and
Providers,
156
National Conferences and Meetings,
157
Suggestions of "Other Entities,"
157
Research Challenges,
157
Strength of Research Conclusions,
158
References,
159
7
STRUCTURE AND FINANCES
160
Structure of QIOs,
160
QIO Support Centers,
173
Finances of QIOs,
179
Summary,
188
References,
190
8
TECHNICAL ASSISTANCE FOR QUALITY
IMPROVEMENT
192
Defining Technical Assistance,
193
Recruitment of Identified Participants,
193
Interaction with Providers,
197
Technical Assistance During the 7th and 8th SOWs,
199
Nursing Homes,
201
Home Health,
205
Hospitals,
208
Physicians' Offices and Practices,
213
Underserved and Rural Beneficiaries,
218
Managed Care,
221
QIO Support Centers,
223
Summary,
227
References,
228
9
IMPACT OF TECHNICAL ASSISTANCE FOR QUALITY
IMPROVEMENT AND KNOWLEDGE TRANSFER
230
Quality Improvement,
230
Approaches to Quality Improvement,
239
Knowledge Transfer,
243
Summary,
252
References,
252
xx
CONTENTS
10 EVALUATION
OF QUALITY IMPROVEMENT
ACHIEVED BY THE QIO PROGRAM
257
CMS Evaluation of QIO Performance on Technical
Assistance Tasks,
257
IOM Analysis of Task
1
Performance by QIOs,
262
Impact of Intense QIO Assistance,
272
Provider Satisfaction,
273
Programwide Evaluation of Impact,
276
Summary,
277
References,
278
11
BENEFICIARY EDUCATION AND COMMUNICATIONS
279
Task 2a: Promoting the Use of Performance Data,
279
Task 2b: Transitioning to Hospital-Generated Data,
285
Task 2c: Other Mandated Communications Activities,
287
Role of QIOs in Beneficiary Education: Telephone Interviews,
288
QIO Support Centers in the 7th and 8th SOWs,
293
Summary,
295
References,
295
12
PROTECTION OF MEDICARE BENEFICIARIES AND
PROGRAM INTEGRITY
297
Case Review Activities in the 7th SOW,
298
Mediation in the 7th SOW,
307
Medicare Beneficiary Protection QIOSC,
308
QIO Performance Evaluation in the 7th SOW,
310
Case Review Activities in the 8th SOW,
310
Hospital Payment Monitoring Program in the 7th SOW,
311
HPMP in the 8th SOW,
315
Impact of Protective Activities in the 7th SOW,
318
Summary,
322
References,
323
13
CMS OVERSIGHT
325
Organizational Structure of QIO Program in CMS,
325
Communications and Information Technology Services,
333
Data Flow,
341
Data Lag Issues,
343
QIO Contracts,
345
Overall Program Guidance,
351
Summary,
358
References,
359
CONTENTS xxi
APPENDIXES
A SUPPORTING TABLES
363
В
PRIVATE-SECTOR ORGANIZATIONS OFFERING
SERVICES RELATED TO QUALITY IMPROVEMENT
435
С
APPROACHES TO EVALUATION DESIGN
466
D
GLOSSARY AND ACRONYMS
473
E
COMMITTEE BIOGRAPHIES
481
INDEX
501 |
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| series2 | Pathways to quality health care |
| spelling | Medicare's quality improvement organization program maximizing potential Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, Board on Health Care Services, Institute of Medicine of the National Academies Washington, D.C. National Acad. Press 2006 XXI, 518 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Pathways to quality health care "This study was supported by Contract No. HHSM-500-2004-00010C between the National Academy of Sciences and the United States Department of Health and Human Services through the Centers for Medicare and Medicaid Services"--T.p. verso. Includes bibliographical references and index -- Also issued online. Medicare Quality control Medical care United States Quality control Health care reform United States Medicare organization & administration Quality Assurance, Health Care organization & administration United States Health Care Reform organization & administration United States Quality of Health Care organization & administration United States Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Reform (DE-588)4115716-3 gnd rswk-swf USA USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Gesundheitswesen (DE-588)4020775-4 s Reform (DE-588)4115716-3 s DE-604 http://www.nap.edu/catalog/11604.html http://www.loc.gov/catdir/toc/ecip0613/2006014099.html Table of contents Digitalisierung UB Bayreuth application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016960032&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Medicare's quality improvement organization program maximizing potential Medicare Quality control Medical care United States Quality control Health care reform United States Medicare organization & administration Quality Assurance, Health Care organization & administration United States Health Care Reform organization & administration United States Quality of Health Care organization & administration United States Gesundheitswesen (DE-588)4020775-4 gnd Reform (DE-588)4115716-3 gnd |
| subject_GND | (DE-588)4020775-4 (DE-588)4115716-3 (DE-588)4078704-7 |
| title | Medicare's quality improvement organization program maximizing potential |
| title_auth | Medicare's quality improvement organization program maximizing potential |
| title_exact_search | Medicare's quality improvement organization program maximizing potential |
| title_exact_search_txtP | Medicare's quality improvement organization program maximizing potential |
| title_full | Medicare's quality improvement organization program maximizing potential Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, Board on Health Care Services, Institute of Medicine of the National Academies |
| title_fullStr | Medicare's quality improvement organization program maximizing potential Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, Board on Health Care Services, Institute of Medicine of the National Academies |
| title_full_unstemmed | Medicare's quality improvement organization program maximizing potential Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, Board on Health Care Services, Institute of Medicine of the National Academies |
| title_short | Medicare's quality improvement organization program |
| title_sort | medicare s quality improvement organization program maximizing potential |
| title_sub | maximizing potential |
| topic | Medicare Quality control Medical care United States Quality control Health care reform United States Medicare organization & administration Quality Assurance, Health Care organization & administration United States Health Care Reform organization & administration United States Quality of Health Care organization & administration United States Gesundheitswesen (DE-588)4020775-4 gnd Reform (DE-588)4115716-3 gnd |
| topic_facet | Medicare Quality control Medical care United States Quality control Health care reform United States Medicare organization & administration Quality Assurance, Health Care organization & administration United States Health Care Reform organization & administration United States Quality of Health Care organization & administration United States Gesundheitswesen Reform USA |
| url | http://www.nap.edu/catalog/11604.html http://www.loc.gov/catdir/toc/ecip0613/2006014099.html http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016960032&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |