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Medicare -- Copyright -- Contents -- 1 Overview Of The Study To Design A Strategy For Quality Review And Assurance In Medicare -- STUDY COMMITTEE AND TECHNICAL ADVISORY PANEL -- CONDUCT OF THE STUDY -- Phases Of The Study -- Data Collection And Other Study Activities -- Main Study Tasks -- Hospital Conditions Of Participation -- Medicare Peer Review Organizations -- CONCLUDING REMARKS -- 2 Oral And Written Testimony From The Public Hearings -- METHODS -- Invitations To Submit Testimony -- Respondents To The Invitations -- Types Of Documents Submitted -- Development And Testing Of Abstract Form -- Data Base System -- Limitations Of The Analysis -- FINDINGS -- Main Themes -- Gaps In Information -- Peer Review -- Access Issues -- Patient-Physician Relationship -- Role Of The Elderly In Quality Assessment And Assurance And Health Care Decision Making -- Interrelationship Of Quality, Costs, And Financing -- Patient-Centered Quality Assurance System -- Clinical Guidelines, Specialty Board Certification, And Credentialing -- Need To Measure, Demonstrate, And Prove Performance Competency -- Assessing The Needs Of The Elderly -- Continuous Quality Improvement -- Responses To Specific Questions -- Defining Quality Of Care -- Assessment Of Contemporary Health Care -- Cost Containment And Quality Health Care -- Medicare Benefits -- Costs Of Quality Assessment And Assurance Activities -- Assessment Of Adequacy Of Quality Assessment And Assurance -- Comments Of Pros -- Comments of Superpro -- Comments Of Other Groups Conducting External Quality Reviews -- Comments Of Third-Party Payers And Purchasers -- Comments Of Direct Care Providers -- Most Effective And Least Effective Activities -- Adequacy Of Current Level Of Quality Assessment -- Adequacy Of Current Quality Assessment And Assurance Tools Or Methods.

Clinical Practice Guidelines -- Copyright -- Acknowledgments -- Contents -- Summary -- CONTEXT -- OVERVIEW OF PRACTICE GUIDELINES INITIATIVES -- Public Initiatives -- Private Initiatives -- INSTITUTE OF MEDICINE COMMITTEE AND PROJECT -- FINDINGS AND CONCLUSIONS -- State of the Art -- Ahcpr and the Forum -- Roles of Public and Private Sectors -- RECOMMENDATIONS: DEFINITIONS -- RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES -- RECOMMENDATIONS: IMPLEMENTATION AND EVALUATION -- DIVERSITY IN CLINICAL PRACTICES AND GUIDELINES -- EXPECTATIONS FOR PRACTICE GUIDELINES -- NEXT STEPS FOR THE INSTITUTE OF MEDICINE -- FINAL COMMENT -- 1 Introduction and Background -- CONTEXT -- OVERVIEW OF PRACTICE GUIDELINES INITIATIVES -- Public Initiatives -- Private Initiatives -- SPECIFIC RESPONSIBILITIES OF AHCPR -- Deadlines and Priorities -- Development Procedures and Requirements -- Dissemination -- Use of Guidelines -- Evaluation and Further Research -- THE INSTITUTE OF MEDICINE COMMITTEE AND PROJECT -- OVERVIEW OF THE REPORT -- CONCLUSIONS AND CAUTIONARY NOTES -- REFERENCES -- 2 Definitions of Key Terms -- THE COMMITTEE'S APPROACH -- PRACTICE GUIDELINES -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Practice Guideline -- Guidelines and the Strength of Evidence -- Relation of Guidelines to Review Criteria and Other Evaluation Tools -- Definition of Appropriate Care -- Guidelines and Costs -- EVALUATION INSTRUMENTS -- MEDICAL REVIEW CRITERIA -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Medical Review Criteria -- STANDARDS OF QUALITY -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Standards of Quality -- PERFORMANCE MEASURES -- Common Usage: The Dictionary -- Professional and Technical Usage.

Emergency Medical Services for Children -- Copyright -- Preface -- Acknowledgments -- Contents -- Summary -- RECOGNIZING A NEED FOR EMERGENCY MEDICAL SERVICES FOR CHILDREN -- Origins of the Study and Report -- A Vision of Emergency Medical Services for Children -- Children and Why They Need Special Attention -- Epidemiological Considerations -- Key Historical Developments -- PRIORITY ISSUES IN IMPROVING EMERGENCY MEDICAL SERVICES FOR CHILDREN -- Education and Training -- Programs for the Public -- Programs for Health Care Professionals -- Putting Essential Tools in Place -- Communication -- Public Access to Emergency Services -- Communication Within EMS Systems -- Communication About EMS-C -- Planning, Evaluation, and Research -- Meeting Data Needs for Planning and Evaluation -- Research -- Leadership at the Federal and State Levels -- Agencies and Advisory Councils -- Funding -- LOOKING TO THE FUTURE -- Issues of Benefits and Costs -- A Changing Health Care Environment -- Health Care Reform -- Special Challenges to EMS and EMS-C -- FINAL THOUGHTS -- 1 Introduction -- THE ISSUE: ENSURING EMERGENCY MEDICAL CARE FOR CHILDREN WHO NEED IT -- THE INSTITUTE OF MEDICINE STUDY -- Origins of the Study -- Conduct of the Study -- A VISION OF THE IDEAL SYSTEM: ESTABLISHING CRITICAL LINKAGES -- Linking Components of EMS-C -- Linking Children to EMS -- Linking Emergency Care to Children's Health Care -- GUIDING PRINCIPLES -- ORGANIZATION OF THE REPORT -- AUDIENCE FOR THIS REPORT -- THE COMMITTEE'S GOAL -- NOTE -- 2 Risking Our Children's Health: A Need for Emergency Care -- DEFINITIONS -- Children -- Emergency Medical Services -- WHY CHILDREN NEED SPECIAL ATTENTION -- Children Differ from Adults -- Anatomy and Physiology -- Emotional and Behavioral Development -- Patterns of Morbidity and Mortality -- Special Concerns in Caring for Children.

AbstractQuality of care can be defined, measured, and improved but the tools available for quality assurance and improvement in mental health and substance abuse are lessfully developed and more difficult to apply, especially in the managed care arena.

MEDICARE -- Copyright -- Contents -- Preface -- Introduction to the Study and This Report -- CONGRESSIONAL CHARGE -- STUDY METHODS -- ORGANIZATION OF THIS REPORT -- Summary -- FINDINGS AND CONCLUSIONS -- A MODEL OF QUALITY ASSURANCE FOR MEDICARE -- DEFINING QUALITY OF CARE -- RECOMMENDATIONS -- Medicare Mission and Quality Assurance -- Quality Assurance Goals of the Medicare Program -- Medicare Program to Assure Quality (MPAQ) -- Public Accountability and Evaluation -- Hospital Conditions of Participation -- Research and Capacity Building -- FUNDING -- ORGANIZATIONAL AND OPERATIONAL FEATURES OF THE MEDICARE PROGRAM TO ASSURE QUALITY -- Starting Points -- Structure -- The Federal and Local Levels -- The Internal Organization-Based Level -- Operational Overview of the Proposed Model -- An Emphasis on Outcomes -- The Importance of the Process of Care -- Continuity of Quality Assessment -- Potential Problems -- IMPLEMENTATION STRATEGY AND PHASES -- Phase I: Years 1 and 2 -- Phase II: Years 2 through 8 -- Data Collection -- Data Analysis Capabilities -- Information Dissemination -- Special Projects -- Phase III: Years 9 and 10 -- CONCLUDING REMARKS -- 1 Health, Health Care, and Quality of Care -- DEFINING QUALITY OF HEALTH CARE -- Elements of the Committee's Definition -- Implications of the Committee's Definition -- HEALTH AND HEALTH CARE IN THE UNITED STATES -- Health and Illness -- Structure of the U.S. Health Care System -- Major Health Policy Issues with Implications for Quality of Care -- Health Care Expenditures -- Access to Services -- Settings of Care -- Integration of Financing and Delivery of Services -- Utilization Management and Utilization Review -- Medicare's Physician Payment System -- Summary -- QUALITY OF HEALTH CARE AS A PUBLIC POLICY ISSUE -- Burden of Harm of Poor Quality.

Patient-reported outcomes (PROs) are measures of how patients feel or what they are able to do in the context of their health status; PROs are reports, usually on questionnaires, about a patient's health conditions, health behaviors, or experiences with health care that individuals report directly, without modification of responses by clinicians or others; thus, they directly reflect the voice of the patient. PROs cover domains such as physical health, mental and emotional health, functioning, symptoms and symptom burden, and health behaviors. They are relevant for many activities: helping patients and their clinicians make informed decisions about health care, monitoring the progress of care, setting policies for coverage and reimbursement of health services, improving the quality of health care services, and tracking or reporting on the performance of health care delivery organizations. We address the major methodological issues related to choosing, administering, and using PROs for these purposes, particularly in clinical practice settings. We include a framework for best practices in selecting PROs, focusing on choosing appropriate methods and modes for administering PRO measures to accommodate patients with diverse linguistic, cultural, educational, and functional skills, understanding measures developed through both classic and modern test theory, and addressing complex issues relating to scoring and analyzing PRO data.