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May 16, 1990, Vol 263, No. 19 >
ARTICLE | May 16, 1990

Quality Assurance FREE

Stephen F. Jencks, MD, MPH
JAMA. 1990;263(19):2679-2681. doi:10.1001/jama.1990.03440190135073
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References

The most important development in quality assurance in the past few years has been a shift in focus from processes of care to outcomes of care. A growing role for governments and large purchasers and an increasing use of large data sets has accompanied this change of focus.

At least three states (Pennsylvania, Iowa, and Colorado) now have a state commission that must collect data on the quality of care in the state's hospitals. All three commissions have chosen an approach based on collecting clinical data that will allow comparison of risk-adjusted outcomes among hospitals. Other states, including Maryland, Ohio, New Hampshire, Washington, and Maine, are engaged in state-level voluntary or official activities aimed at comparing hospital performance, physician activities in small areas, or outcomes of various kinds of care.

Third parties are intensely and aggressively interested in the quality and appropriateness of care. Business coalitions are largely responsible for

REFERENCES

1 +
Hospital Effectiveness Report . Harrisburg: Pennsylvania Health Care Cost-Containment Council; 1989;;1. Publication HE5.
2 +
Green J, Wintfeld N, Sharkey P, Passman LJ.  The importance of severity of illness in assessing hospital mortality . JAMA . 1990;;263:241-246.
3 +
Krakauer H, Bailey RC, Skellan KJ, et al. Evaluation of the Model Used by the Health Care Financing Administration for the Analysis of Mortality Following Hospitalization . Baltimore, Md: Health Care Financing Administration; 1990;.
4 +
Hartz AJ, Krakauer H, Kuhn EM, et al.  Hospital characteristics and mortality rates . N Engl J Med . 1989;;321:1720-1725.
5 +
DuBois RW, Rogers WH, Moxley JH, Draper D, BrookRH.  Hospital inpatient mortality: is it a predictor of quality? N Engl J Med . 1987;;317:1674-1679.
6 +
Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J.  Interpreting hospital mortality data: the role of clinical risk adjustment . JAMA . 1988;;260:3611-3616.
7 +
Donabedian A.  The quality of care: how can it be assessed? JAMA . 1988;;260:1743-1748.
8 +
Berwick DM, Wald DL.  Hospital leaders' opinions of the HCFA mortality data . JAMA . 1990;;263:247-249.
9 +
Eddy DM, Billings J.  The quality of medical evidence . Health Aff (Millwood) . (Spring) 1988;;7:19-32.
10 +
 Effectiveness in health care: an initiative to evaluate and improve medical practice . N Engl J Med . 1988;;319:1197-1202.
11 +
Relman AS.  Assessment and accountability: the third revolution in medical care . N Engl J Med . 1988;;319:1220-1222.
12 +
Park RE, Fink A, Rook RH, et al.  Physician ratings of appropriate indications for three procedures: theoretical indications vs indications used in practice . Am J Public Health 1989;;79:445-447.
13 +
Institute of Medicine. Effectiveness and Outcomes in Health Care: Proceedings of an Invitational Conference . Washington, DC: National Academy Press. In press.
14 +
Fowler FJ, Wennberg JE, Timothy RP, Barry MJ, Mulley AG, Hanley D.  Symptom status and quality of life following prostatectomy . JAMA . 1988;;259:3018-3022.
15 +
Rehospitalization Following 8 Surgical Procedures for Aged Medicare Beneficiaries, 1986-1987 . Baltimore, Md: Health Care Financing Administration. In press.
16 +
Sullivan L. The Impact of the Medicare Prospective Payment System 1987 . Washington, DC: Dept of Health and Human Services; 1989;.
17 +
Kahn KL, Brook RH, Draper D, et al.  Interpreting hospital mortality data: how can we proceed? JAMA . 1988;;260:3625-3628.
18 +
Kahn KL, Rubenstein LV, Kosecoff J, et al.  DRG-based prospective payment system and quality of care . Clin Res . 1989;;37:315A. Abstract.
19 +
Fitzgerald JF, Fagan JF, Tierney WM, Dittus RS.  Changing patterns of hip fracture care before and after implementation of the prospective payment system . JAMA . 1987;;258:218-222.
20 +
Fitzgerald JF, Moore PS, Dittus RS.  The care of elderly patients with hip fracture: changes since implementation of the prospective payment system . N Engl J Med . 1988;;319:1392-1397.
21 +
Vladek BC.  Hospital prospective payment and the quality of care . N Engl J Med . 1988;;319:1411-1413.
22 +
Laffel G, Blumenthal D.  The case for using industrial quality management science in health care organizations . JAMA . 1989;;262:2869-2873.
23 +
Berwick DM.  Continuous improvement as an ideal in health care . N Engl J Med . 1989;;320:53-56.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hospital Effectiveness Report . Harrisburg: Pennsylvania Health Care Cost-Containment Council; 1989;;1. Publication HE5.
2 +
Green J, Wintfeld N, Sharkey P, Passman LJ.  The importance of severity of illness in assessing hospital mortality . JAMA . 1990;;263:241-246.
3 +
Krakauer H, Bailey RC, Skellan KJ, et al. Evaluation of the Model Used by the Health Care Financing Administration for the Analysis of Mortality Following Hospitalization . Baltimore, Md: Health Care Financing Administration; 1990;.
4 +
Hartz AJ, Krakauer H, Kuhn EM, et al.  Hospital characteristics and mortality rates . N Engl J Med . 1989;;321:1720-1725.
5 +
DuBois RW, Rogers WH, Moxley JH, Draper D, BrookRH.  Hospital inpatient mortality: is it a predictor of quality? N Engl J Med . 1987;;317:1674-1679.
6 +
Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J.  Interpreting hospital mortality data: the role of clinical risk adjustment . JAMA . 1988;;260:3611-3616.
7 +
Donabedian A.  The quality of care: how can it be assessed? JAMA . 1988;;260:1743-1748.
8 +
Berwick DM, Wald DL.  Hospital leaders' opinions of the HCFA mortality data . JAMA . 1990;;263:247-249.
9 +
Eddy DM, Billings J.  The quality of medical evidence . Health Aff (Millwood) . (Spring) 1988;;7:19-32.
10 +
 Effectiveness in health care: an initiative to evaluate and improve medical practice . N Engl J Med . 1988;;319:1197-1202.
11 +
Relman AS.  Assessment and accountability: the third revolution in medical care . N Engl J Med . 1988;;319:1220-1222.
12 +
Park RE, Fink A, Rook RH, et al.  Physician ratings of appropriate indications for three procedures: theoretical indications vs indications used in practice . Am J Public Health 1989;;79:445-447.
13 +
Institute of Medicine. Effectiveness and Outcomes in Health Care: Proceedings of an Invitational Conference . Washington, DC: National Academy Press. In press.
14 +
Fowler FJ, Wennberg JE, Timothy RP, Barry MJ, Mulley AG, Hanley D.  Symptom status and quality of life following prostatectomy . JAMA . 1988;;259:3018-3022.
15 +
Rehospitalization Following 8 Surgical Procedures for Aged Medicare Beneficiaries, 1986-1987 . Baltimore, Md: Health Care Financing Administration. In press.
16 +
Sullivan L. The Impact of the Medicare Prospective Payment System 1987 . Washington, DC: Dept of Health and Human Services; 1989;.
17 +
Kahn KL, Brook RH, Draper D, et al.  Interpreting hospital mortality data: how can we proceed? JAMA . 1988;;260:3625-3628.
18 +
Kahn KL, Rubenstein LV, Kosecoff J, et al.  DRG-based prospective payment system and quality of care . Clin Res . 1989;;37:315A. Abstract.
19 +
Fitzgerald JF, Fagan JF, Tierney WM, Dittus RS.  Changing patterns of hip fracture care before and after implementation of the prospective payment system . JAMA . 1987;;258:218-222.
20 +
Fitzgerald JF, Moore PS, Dittus RS.  The care of elderly patients with hip fracture: changes since implementation of the prospective payment system . N Engl J Med . 1988;;319:1392-1397.
21 +
Vladek BC.  Hospital prospective payment and the quality of care . N Engl J Med . 1988;;319:1411-1413.
22 +
Laffel G, Blumenthal D.  The case for using industrial quality management science in health care organizations . JAMA . 1989;;262:2869-2873.
23 +
Berwick DM.  Continuous improvement as an ideal in health care . N Engl J Med . 1989;;320:53-56.

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