The health care quality improvement initiative. A new approach to quality assurance in Medicare

TLDR

The Health Care Financing Administration is reshaping its approach to improving care for Medicare beneficiaries, signaling profound changes. The Health Care Quality Improvement Initiative seeks to shift focus from individual clinical errors to enhancing mainstream care for providers. Peer review organizations will employ explicit, nationally uniform criteria to examine care patterns, target persistent gaps, and guide providers toward solutions through monitoring.

Abstract

THIS ARTICLE describes how the Health Care Financing Administration (HCFA) is reshaping its approach to improving care for Medicare beneficiaries. The goal of the Health Care Quality Improvement Initiative (HCQII) is to move from dealing with individual clinical errors to helping providers to improve the mainstream of care. Such a reform implies profound changes. First, the processes and criteria for review change: instead of having clinicians use essentially intuitive local criteria to find problems in individual cases, peer review organizations (PROs) will use explicit, more nationally uniform criteria to For editorial comment see p 917. examine patterns of care and patterns of outcomes. Second, the immediate objective changes: PROs will focus primarily on persistent differences between the observed and the achievable in both care and outcomes and less on occasional, unusual deficiencies in care. Third, the ultimate method changes: PROs will help providers identify problems and their solutions by monitoring