We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

The Challenge to Improve Quality of Care

Lawrence D. Ramunno, MD, MPH; T. Andrew Dodds, MD, MPH
JAMA. 1998;279(13):992-993. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-13-jbk0401.
Text Size: A A A
Published online


To the Editor.—While we applaud the efforts of Drs Lundberg and Wennberg1 with their challenge to the medical profession, a challenge that has been notably long absent, their call already has been answered, at least in part, and, ironically, reported in JAMA.2

Structurally, the suggested framework of their proposal for a program addressing quality improvement currently exists in the Health Care Financing Administration Peer Review Organization (PRO) program that has been in place since 1984. This quality improvement infrastructure, required by the Social Security Act for the Medicare program, is in place for every state and US territory. Despite past references to governmental slowness, the Health Care Financing Administration remains at the forefront of quality improvement with its PRO Health Care Quality Improvement Initiative. Specifically, PROs, in conjunction with local and national collaborators, already identify high prevalence and high impact medical conditions as targets for quality improvement and use all the methods that Lundberg and Wennberg propose as a means to obtain measurable improvement. Well-documented improvements have occurred and more are sure to come.3,4 Of the suggested topics for intervention, the National Cooperative Cardiovascular Project is just one example where measurable improvements in the PRO community have already occurred on a local, regional, and national level for use of β-blockers and for several other indicators. The PRO program could be expanded to provide the infrastructure for all patients, and there are compelling reasons to expand the scope of this program. The federal government remains the largest purchaser of health care in the United States, and while the private sector has demonstrated the capacity to adapt to a changing market, there is concern that cost rather than quality is the driving factor.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.