Quality Improvement Organizations
Due to the sensitive nature of healthcare policies, in terms of development and implementation at the grassroots, it is essential that there are a number of watchdogs and observers charged with the responsibility of ensuring there is provision of quality health care. Such organizations monitor the effectiveness, quality and appropriateness of care given. These organizations essentially attempt to ensure that the care provided to Medicare beneficiaries is of the right standard. These institutions include organizations like Mountain-Pacific Quality Health Foundation, Colorado Foundation for Medical Care and The Joint Commission.
Mountain-Pacific Quality Health Foundation
This is an affiliation of four quality improvement organizations with the same goal of ensuring improvement of the quality of care as well as increased utilization of health care services. The organization is physician sponsored and serves as part of a wider network of quality improvement organizations operating in Wyoming, Montana, Alaska and Hawaii, under the direction of CMS (Centers for Medicare & Medicaid Services). The organization therefore supports patients, providers as well as other stakeholders with an aim of realizing better care and lowering costs, through the improvement of quality. The duties of the organization as mandated by the CMS are to: engage providers, thus bring about the use of best evidence based practice, which will in turn lead to rapid and widespread improvements in the quality of care. Secondly the organization is to empower patients by encouraging them to play a more active role in their own care, as well as in managing their own health. Finally, the organization was mandated to encourage collaboration between the various community stakeholders as well as among the providers themselves in order to encourage greater exchange of ideas, expertise and experience. This has led to greater flexibility when it comes to response to local needs, and even better quality health care provision.
The Joint Commission
The Joint Commission, previously known as JCAHO, is a non profit United States based quality improvement organization that provides accreditation to over 19,000 healthcare programs and institutions within the United States. This has gradually become a prerequisite for licensure as well as receipt of Medicaid reimbursement by most state governments. The organization therefore effectively ensures quality healthcare by offering its accreditation to only the healthcare programs and institutions that meet the threshold for the required level of quality. The organizations purpose is best captured within its mission, which in a nutshell commits it to improving the quality of health care through evaluation, with an aim of inspiring institutions to provide effective and safe care. The organization uses inspections carried out triennially to create accreditation quality reports usually made available to the public, the basis upon which reimbursements are done. This usually serves as a motivating factor for the institutions to either improve their quality of care, or maintain the already existing standards. In addition to the surveys, the commission also ensures improvements in patient safety by establishing National Patient Safety Goals, which it enforces and promotes in participating healthcare institutions.
The end result of the participation of The Joint Commission through accreditation has been positive, as evidenced by the findings of Alkhenizan and Shaw (2011). These findings therefore suggest that indeed there is a need to support the accreditation programs, as they result in better quality of care, and better disease outcomes due to increased provider effort and participation.
The Colorado Foundation for Medical Care
The Colorado foundation for Medical Care is the quality improvement organization for the state of Colorado, and serves its purpose by working with health providers, managed care companies as well as government programs to realize improvements in the quality of healthcare. The overriding purpose of the organization is actually to improve the quality of care, through reviewing the manner through which cases are managed, offering continuing education courses for Nurses and Physicians, determining payment accuracy among other approaches. The organization provides consultancy services to health care providers on the issues of quality control, regulatory compliance, improvement and assurance. The organization also provides medical abstraction services when it comes to clinical trials as well as other health related data collection activities. This deep involvement not just in terms of quality assurance, but also in terms of career development and evidence based practice, definitely ensures that the organization carries out its mandate to ensure that the quality of care is of the required standard. The good work and improved quality of care has led to the organization being awarded a contract by CMS as the quality improvement organization for Colorado.
Overall quality improvement organizations through their involvement over the past few years led to a great improvement in health care, more so in outpatient care. This has come about due to greater effort and participation from the health care providers, either voluntarily or involuntarily in order to meet the standards set by most of these quality improvement organizations. Statistics such as the ones provided by Wu, Chen and Shih, (2006), over the effects of QIOs on provider participation and improvement, suggest an absolute effect, and may prompt further involvement by the quality improvement organizations.
Alkhenizan, A., & Shaw, C. (2011). Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature. Ann Saudi Med 31(4), 407- 416
About CFMC. Retrieved from http://www.cfmc.org/about/about_index.aspx
Mountain-Pacific Quality Health. Retrieved from http://www.mpqhf.com/janda/inner.php?PageID=110
The Joint Commission. Retrieved from http://www.jointcommission.org/
Wu, W., Chen, J., & Shih, A. (2006). Effect of quality improvement organization activities on outpatient diabetes care in eastern New York State. Medical Care 44(12), 1142-1147.