Quality health care has for a long time become a major concern for many scholars and researchers in America. It is very significant to have the understanding of who receives the health care, the appropriateness of the care as well as the problems associated with quality care provision and access. For any health care system to be efficient and reliable, assessments, analysis, and monitoring are very critical in order to make changes and improvements in the different health care departments. In America, Quality Improvement Organizations have been working closely to ensure a proper health care system (Sollecito and Johnson, 2018). This essay will explain what is meant by Quality Improvement Organizations, explain their history and how they came into existence, as well as their functions. In addition, their statutory authority will be discussed, as well as how these organizations are managed. Moreover, two current Quality Improvement Organizations will be highlighted where their current work that they are getting engaged in will be discussed. Finally, their contribution towards the healthcare quality status in America will be covered.
What are Quality Improvement Organization?
Quality Improvement Organizations are groups of physicians, clinicians, doctors, consumers as well as experts in health quality care, who work together to ensure improvement in the safety, delivery as well as the efficiency in the American health care system. This is according to Sollecito and Johnson (2018). These are mostly non-profit organizations which are private in nature which link with hospitals, nursing homes, and other health institutions in order to make sure that they use the most current techniques as well as practices which are proven clinically in the objective of delivering health care of the highest and safest quality. They also analyze records from patients to look at areas which require improvements as well as addressing patient’s complaints. The complaints from the beneficiaries of health care may be touching on the conditions of the hospital or competence of a particular professional in the delivery and provision of health care (Sollecito and Johnson, 2018).
History and Functions of Quality Improvement Organizations
The origin of Quality Improvement Organizations began in the year 1965, in the times of Lyndon Johnson who was the president by then. It is at these times when bills were signed to include Medicare in the social security coverage. In the year 1982, they were termed as Peer Review Organizations where they had the role of inspecting health care institutions to protect beneficiaries of Medicare from being provided with poor and unnecessary health services (Parry, 2014). Sollecito and Johnson, (2018) say that a great milestone was achieved in the year 1996 where the Peer Review Organizations were now able to conduct data collection, progress measurement and identification of areas which needed improvement.
They also started focusing on specific common diseases like diabetes by improving how they are managed (McFadden, Stock, and Gowen III, 2015). They were successful in the achievement of their goals of enhancing quality health care as well as cost containment. A renaming of the Peer Review Organizations took place in the year 2002 to Quality Improvement Organizations (Sollecito and Johnson, 2018). In these organizations, all team members in health care such as the management, physicians, and nurses started working together with the main aim of improving health care quality. They helped families, patients as well as health care providers in carrying out local activities which would result in progress not only in the local communities but also in the entire nation.
Statutory Authority for Quality Improvement Organizations
In the statutory authorities governing the Quality Improvement Organizations, Section 1154(a) (18) of the Social Security Act, the organization is supposed to perform and remain in the roles and objectives that are stated, adhering to the terms and conditions of the contract (Jencks, 2013). Activities which may be taken by the organizations to improve the quality of health care, as long as they are efficient and reasonable are supposed to be paid for in reference to title XVIII of the Social Security Act. A patient who has a problem which requires care improvement can be allowed to be handled by the Quality Improvement Organizations for the purpose of assessing, analyzing, intervening as well as resolving the problem and making a follow-up, according to the definition in Article 42, Part 480, Section 101 of the Social Security Act. 42 CFR 476. 1 defines quality initiative as any activity designed for the purpose of improving health care quality by using proven methodologies (Jencks and Wilensky, 2013). The improvement initiative should involve communities, practitioners, beneficiaries and health care providers where the aim of the improvement should relate to cost containment, safety, and health care.
In Section 1160(a) (3) of 480. 103, Quality Improvement Organizations are required by the Act to maintain evidence concerning the health care services provided to Medicare patients. Section 1160 states that confidentiality and disclosure of information regarding Quality Improvement Organizations should be maintained in the best way possible where exceptions are outlined in Title XI Part B of the Act (Jencks and Wilensky, 2013). Any person who discloses any information which is not outlined in the exceptions will suffer the consequences upon conviction including a fine of not more than $1000, or imprisonment of not more than six months, or both the fine and the imprisonment where costs incurred in the prosecution are also to be paid for. According to Article 480. 111 of the Act, Quality Improvement Organizations are given authority to retrieve and access records kept by health care institutions or practitioners concerning information of the services provided by the institutions or concerning Medicare patients (Jencks and Wilensky, 2013).
Agency for Healthcare Research and Quality
Agency for Healthcare Research and Quality is an American organization which is focused and committed to ensuring a quality, safe, efficient and effective health care to all the American people. As the name suggests, this organization involves itself into carrying out research which gives data which is reliable and useful for making relevant and necessary changes and improvements in the health care system. This involves helping people in order to make significant decisions concerning health care (Sollecito and Johnson, 2018). The decisions that they make may have an influence in the reduction of health care costs, enhancement of patient safety, reduction of medical errors as well as broadening effective health care service accessibility (Berkman et al, 2013).
Everyone with Diabetes Counts
A program known as Everyone with Diabetes Counts has been very critical in enhancing health care quality in America. It has been offering literacy to beneficiaries of Medicare services as well as Medicare-Medicaid, who have diabetes and also to those are pre-diabetic. Additionally, Wu., Jiang and Di Lonardo (2018) suggest that this program has been targeting Medicare beneficiaries who reside in racial/ethnic minority areas as well as rural populations which are medically underserved. They have also been involved in carrying out tests such as the foot and eye exams, control of blood pressure weight and lipids test. These tests help in the improvement of the health scores and eventually leading to the decrease in diabetes testing disparities. Everyone with Diabetes Counts program supports education on diabetes through the partnership and engagement of the public as well as private agencies and organizations both at the community level, state level and the national level (Wu., Jiang and Di Lonardo, 2018).
Contribution of Quality Improvement Organizations in American Healthcare
Quality Improvement Organizations have transformed the state of health care in America in many ways. Many diseases that were very common some years ago have been reduced such as diabetes and pressure ulcers (Brock et al, 2013). Unnecessary readmissions in hospitals and antipsychotic medication use have been reduced due to improvements that have been brought in the health care by the Quality Improvement Organizations (Sollecito and Johnson, 2018). Equipment, tools and other technical assistance devices have been developed and brought into the health care system in order to make patient care more effective, efficient and reliable, which has saved the lives of many Americans (Mitra, 2016).
Strong partnerships have been established as well as collaboration between the Quality Improvement Organizations and other stakeholders and patients. Health care agencies such as the Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality have been linked to these organizations with the aim of improving the broad and entire health care system in America (Balasubramanian et al, 2015). Through these partnerships, great mind-minded people who had a similar line of thinking towards the health care system were brought together in the year 2011 through Learning and Action Networks. Surgical complications and infections related to health care have been greatly reduced and prevented through the use of technology. Health care beneficiaries have also been equipped to participate actively in the management of chronic diseases. Medical groups, community-based groups, health plans, and hospital associations have been united to bring a solution and an improvement in the economic, social and medical factors which influence health care (Mitra, 2016). Additionally, Quality Improvement Organizations have worked tirelessly and have ensured that health care centers are accessible to the local community areas and that the services are affordable to everyone across the nation. This has led to equity and equality in the provision of health care services.
Reasons for Low Ranking of American Healthcare System
America has been having a poor rank in the health care despite the efforts by the Quality Improvement Organizations because of several reasons. One of them is because the health care system does not provide doctors and other practitioners with incentives according to the quality of service that they provide (Al-Abri and Al-Balushi, 2014). This, therefore, makes the doctors and practitioners remain unmotivated to do better in terms of quality health care. Another reason is that the health care facilities and services are very expensive, a factor which makes many Americans fail to access them because they cannot afford. Additionally, America has the highest rate of chronic health conditions which makes them spend so much in medical care as compared to the past few decades when chronic diseases were not very common (Dixon-Woods et al, 2013).
Quality Improvement Organizations in America have served greatly and their roles cannot go unappreciated. They have put in place measures that have saved thousands of lives of the Americans through the system of health care. Many improvements have been made and this has brought about the satisfaction of the health care beneficiaries, their comfortable life and general life style have been enhanced. However, these organizations should make use of the most current technologies and continue working closely in the health care system for the betterment of the nation.
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