The campaign for quality improvement dates back to nineteenth-century obstetrician, Ignaz Semmelweis’s time; Semmelweiz campaigned for the significance of healthcare providers washing their hands prior to caring for patients. Furthermore, legendary British nurse, Florence Nightingale, determined the link between high mortality rates among army hospital inpatients and inferior living conditions. Surgeon Ernest Codman initiated hospital standards development, adopting and stressing the significance of healthcare outcome assessment approaches (Colton, 2000). Former US President Johnson, in the year 1965, signed the bill that made Medicare a component of the nation’s Social Security scheme. This bill which was enforced in July of 1966 expanded the three-decade-long Social Security initiative and offered nursing home and hospital care, outpatient treatment and home nursing services to individuals aged above 65 years (QIO News, 2014).
Numerous major attempts at quality improvement have been made in the last 50 years, largely initiated by academicians’ health quality campaign. Examples of such attempts are patient care delivery system reengineering and reorganization, incentivizing inter-institutional/provider competition, and peer review encouragement. Additional efforts were determination of medical procedures influencing patient health, performance assessment, offering rewards for good performance, penalizing poor performers, improving monitoring techniques, public quality data reporting, adopting swiftly-advancing quality improvement instruments, and professional medical education reform (Pearson & Batch, 2010).
History reveals that PROs (the predecessors of QIOs) largely carried out utilization reviews for ensuring Medicare paid for only medically essential care. The preliminary attempts at quality improvement were chiefly restricted to case reviews (i.e., retrospective reviews of individual patient care), and dealing with early de-hospitalizations’ beneficiary appeals.
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In the year 1992, as a reaction to a report by the IOM (Institute of Medicine) which reinforced the idea that distinct cases of inferior quality typically hinted at broader, systemic quality issues, the HCFA (Health Care Financing Administration, now Center for Medicare and Medicaid Services) declared its intent of redirecting PROs’ Medicare efforts to system-based programs for quality improvement, in direct and voluntary collaboration with healthcare providers (McGlynn et al, 2003).
Types of Care-Delivery Organizations and Issues They Face
Large general hospitals and other such healthcare organizations offer a broad array of services like acute care which stretch across several care continuum areas. Meanwhile, hospices and other healthcare organizations that are specialized offer only certain services covering a distinct area of the care continuum. Hospitals can be specialized as well (e.g., rehab centers or psychiatric hospitals). Another form of healthcare organization is the doctor’s office and medical group practices, which can offer only one specialty service or multiple healthcare services including cardiology, neurology and pulmonology. A number of medical groups currently provide services like outpatient surgery, diagnostic testing, and on-site therapeutic services. Ambulatory healthcare organizations cater to individuals who visit to receive care but don’t remain at the center overnight (e.g., outpatient diagnostic centers that carry out medical imaging, laboratory tests, and similar diagnostic services). There are other ambulatory services as well such as surgery centers, psychiatric health centers, primary care centers and urgi-care centers to address….....
Ahluwalia, S. C., Cheryl, L. D., Silverman, M., Motala, A., & Shekelle, P. G. (2017). What Defines a High-Performing Health Care Delivery System: A Systematic Review, The Joint Commission Journal on Quality and Patient Safety, 43, 450–459.
Berwick, D. M. (2002). A user’s manual for the IOM’s ‘quality chasm’ report. Health Aff, 21, 80–90. doi: 10.1377/hlthaff.21.3.80.
Colton, D. (2000). Quality improvement in health care. Conceptual and historical foundations. Eval Health Prof. 23, 7–42. doi: 10.1177/01632780022034462.
McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., Kerr, E. A. (2003). The quality of health care delivered to adults in the United States, Journal of Medicine, 348(26), 2635-2645.
Pearson, S. D., & Bach, P. B. (2010). How medicare could use comparative effectiveness research in deciding on new coverage and reimbursement. Health Affairs, 29.
QIO News. (2014). The history of QIO program. Retrieved from https://qioprogram.org/qionews/articles/history-qio-program