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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.
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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.

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