At the end of the chapter, the reader will be able to:
Describe the various quality functions that different health care organizations are involved in.
Describe three government agencies' and three private organizations' involvement in health care quality.
Define accreditation and identify three health care accreditation organizations.
Describe the structure and activities of public–private partnerships aimed at improving health care quality.
The U.S. health care system spends more per capita on health care than any other country in the world, and yet, the quality is often inferior to other nations and often does not meet expected evidence-based guidelines. There are many reports providing statistics pertaining to care issues in the United States. One study found that 50–60% of patients are nonadherent with medication regimens, especially for chronic, asymptomatic illnesses.1,2 Moreover, non-adherence is a major cause of hospitalizations, emergency room visits, and repeat physician visits. Other studies show 20–30% of geriatric patients are prescribed potentially inappropriate medications.3,4 It is these types of reports that cause concern for government agencies, consumers, employers, providers, payers, and others involved in the U.S. health care system. Thus, these various stakeholders are interested in implementing quality improvement programs in the health care system.
Emerging quality improvement and patient safety movements reflect the realization that some patients do not receive important elements of proper care as measured by performance measures. For the past several years, different organizations have been developing and using quality measures to help determine the rates of provision of critical and widely recognized steps in the care of multiple conditions. Other organizations have been focused on quality improvement interventions and how to encourage providers to improve quality of care. Furthermore, the U.S. health care system is moving toward value-based purchasing. Value is the balance of quality and costs, and therefore, private and public payers for health care are starting to demand evidence of quality. As performance measurements continue to evolve, payers and policy makers are becoming increasingly interested in payment models that reward quality and patient safety.
With the health care system so focused on health care quality, it is not surprising that pharmacy is also being targeted. Organizations are developing quality measures that include medications as well as pharmacy service components. Organizations are encouraging retail pharmacies to adopt quality improvement methods. Organizations are including medication issues and pharmacy service quality as part of their accreditation process. Thus, it is imperative that pharmacists are aware of the many organizations involved in health care quality, and specifically quality of medication use and pharmacy services.
In the last 10 years the number of organizations involved in quality measurement and reporting has grown significantly. In the early 1990s, the Joint Commission, the Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine (IOM), and the National Committee for Quality Assurance (NCQA) were focused on health care quality. Then in 1998, the President's Advisory Commission ...