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External Quality Improvement: Accreditation, Certification, and Education

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Medical Quality Management

Abstract

We define external quality improvement as the review of a physician or healthcare organization’s performance by an external or outside body. Some external review systems have a legal statutory basis and are mandatory, while others are voluntary in nature. Their ultimate goals are to review, evaluate, and rank healthcare organizations based on explicit standards and measurements which can result in significant financial or nonfinancial incentives and sanctions. Legislative and regulatory mandates, market demands for accreditation by consumer groups and payers, and quality improvement efforts by healthcare providers are the backbone for external quality improvement and define the critical role played by these accrediting organizations in the certification of quality in healthcare. This chapter presents information on external quality improvement programs and organizations, including their most recent reports and updated changes and the effect they have on the accreditation and education processes.

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References

  1. Centers for Medicare & Medicaid Services (2019) National Health Expenditure Projections 2015–2025. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2015.pdf

  2. Free Management Library (n.d.) Total quality management. http://www.managementhelp.org/quality/tqm/tqm.htm

  3. American Society for Quality (2019) What is lean? https://asq.org/quality-resources/lean

  4. Kaiser Family Foundation (2019) Employer Health Benefits 2019 Summary of Findings. https://www.kff.org/report-section/ehbs-2019-summary-of-findings/

  5. Neuman P, Cubanski J, Damico A (2015) Medicare per capita spending by age and service: new data highlights oldest beneficiaries. Health Aff Datawatch 34(2):335–339. https://doi.org/10.1377/hlthaff.2014.1371

    Article  Google Scholar 

  6. Garrett N, Martini EM (2007) The boomers are coming: a total cost of care model of the impact of population aging on the cost of chronic conditions in the United States. Dis Manag 10(2):51–60. https://doi.org/10.1089/dis.2006.630

    Article  PubMed  Google Scholar 

  7. Alemayehu B, Warner KE (2004) The lifetime distribution of health care costs. Health Serv Res 39(3):627–642. https://doi.org/10.1111/j.1475-6773.2004.00248.x

    Article  PubMed  PubMed Central  Google Scholar 

  8. U.S. Centers for Medicare and Medicaid Services (2018) CMS’ program history. https://www.cms.gov/About-CMS/Agency-information/History/

  9. U.S. Centers for Medicare and Medicaid Services (n.d.) COBRA continuation coverage questions and answers. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/cobra_qna.html

  10. U.S. Department of Health & Human Services (2017) HIPAA for professionals. https://www.hhs.gov/hipaa/for-professionals/index.html

  11. Agency for Healthcare Research and Quality (2017) Federal Balance Budget Act of 1997: excerpts. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/fbba97.html

  12. Register F (2002) Office of inspector general-health care: Medicare and Medicaid programs; peer review organizations: name and other changes-technical amendments. Fed Regist 67(101):36539–36540

    Google Scholar 

  13. U.S. Centers for Medicare and Medicaid Services (2018) Quality improvement organizations. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html?redirect=/qualityimprovementorgs

  14. Centers for Medicare & Medicaid Services (2019) Accountable Care Organizations (ACOs): general information. https://innovation.cms.gov/initiatives/ACO/

  15. Centers for Medicare & Medicaid Services (n.d.) Quality payment program overview. https://qpp.cms.gov/about/qpp-overview

  16. Centers for Medicare & Medicaid Services (n.d.) MIPS overview. https://qpp.cms.gov/mips/overview

  17. Centers for Medicare & Medicaid Services (n.d.) APMs overview. https://qpp.cms.gov/apms/overview

  18. Centers for Medicare & Medicaid Services (n.d.) Advanced Alternative Payment Models (APMs). https://qpp.cms.gov/apms/advanced-apms

  19. Centers for Medicare & Medicaid Services (2016) 2017 star ratings. https://www.cms.gov/newsroom/fact-sheets/2017-star-ratings

  20. National Committee for Quality Assurance (2019) HEDIS and performance measurement. https://www.ncqa.org/hedis/

  21. U.S. Department of Commerce, National Institute of Standards and Technology (2017) Baldrige Performance Excellence Program: how Baldrige works. https://www.nist.gov/baldrige/how-baldrige-works

  22. U.S. Department of Commerce, National Institute of Standards and Technology (2019) Baldrige Health Care criteria for performance excellence categories and items. https://www.nist.gov/baldrige/baldrige-criteria-commentary-health-care

  23. U.S. Department of Commerce, National Institute of Standards and Technology (2018) The Baldrige feedback report. https://www.nist.gov/baldrige/baldrige-award/feedback-report

  24. U.S. Department of Commerce, National Institute of Standards and Technology (2017) Baldridge Performance Excellence Program 2017 Arroyo Fresco Community Health Center Case Study. https://www.nist.gov/baldrige/2017-arroyo-fresco-community-health-center-case-study

  25. National Committee for Quality Assurance (2019). About NCQA. http://www.ncqa.org/about-ncqa

  26. National Committee for Quality Assurance (2019) State of health care quality. https://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality-report/

  27. National Committee for Quality Assurance (2019) Persistence of Beta-Blocker Treatment after a heart attack (PBH). https://www.ncqa.org/hedis/measures/persistence-of-beta-blocker-treatment-after-a-heart-attack/

  28. URAC (2019) About URAC. https://www.urac.org/about-urac

  29. URAC (2019) URAC: standards and measures at a glance. https://www.urac.org/standards-and-measures-glance

  30. The Joint Commission (2018) Facts about Joint Commission standards. https://www.jointcommission.org/facts_about_joint_commission_accreditation_standards/

  31. The Joint Commission (2019) Achieve the Gold Seal of Approval®. https://www.jointcommission.org/achievethegoldseal.aspx

  32. Healthcare News (2002) Joint Commission debuts new accreditation process “Shared Visions-New Pathways” will redirect the focus of the accreditation process. Healthcare News Nov 2002

    Google Scholar 

  33. The Joint Commission (2018) Facts about the on-site survey process. https://www.jointcommission.org/facts_about_the_on-site_survey_process/

  34. The Joint Commission (2018) Facts about the National Patient Safety Goals. https://www.jointcommission.org/facts_about_the_national_patient_safety_goals/

  35. International Organization for Standardization (ISO) (n.d.) All about ISO. https://www.iso.org/about-us.html

  36. International Organization for Standardization (n.d.) ISO 9000 family – quality management. https://www.iso.org/iso-9001-quality-management.html

  37. American Academy of Family Physicians (2019) Public reporting of physician performance, guiding principles. http://www.aafp.org/about/policies/all/physician-profiling.html

  38. James J (2012) Health policy brief: public reporting on quality and costs. Health Aff 2012:1–5. https://www.healthaffairs.org/do/10.1377/hpb20120308.53696/full/

    Google Scholar 

  39. Colmers J (2007) Public reporting and transparency. The Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2007/feb/public-reporting-and-transparency

  40. Lee VS, Miller T, Daniels C et al (2016) Creating the exceptional patient experience in one academic health system. Acad Med 91:338–334. https://doi.org/10.1097/ACM.0000000000001007

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lee VS (2017) Why my health system collects and publishes patient reviews. In STAT. https://www.statnews.com/2017/02/21/patient-reviews-help-improve-health-care/. Accessed 21 Oct 2019

  42. Lee VS (2016) Why doctors shouldn’t be afraid of online reviews. In HBR.org. https://hbr.org/2016/03/why-doctors-shouldnt-be-afraid-of-online-reviews. Accessed 21 Oct 2019

  43. The Leapfrog Group (n.d.) Mission and vision. http://www.leapfroggroup.org/about/mission-and-vision

  44. The Leapfrog Group (2009) Fact sheet. https://www.bcbsil.com/provider/pdf/7_leapfrog_fact_sheet.pdf

  45. The Leapfrog Group (n.d.) About us. http://www.leapfroggroup.org/about

  46. The Leapfrog Group (2018) Leapfrog Hospital Survey Report Series Issued in 2018. http://www.leapfroggroup.org/ratings-reports/leapfrog-hospital-survey-report-series-issued-2018

  47. Totten AM, Wagner J, Tiwari A, et al (2012) Public reporting as a quality improvement strategy. In closing the quality gap: revisiting the state of the science, Evidence report no. 208. Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  48. QualityNet (n.d.) Public reporting overview. https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1121785350618

  49. Centers for Medicare and Medicaid Services re.gov (2016) Hospital compare. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/hospitalcompare.html

  50. The Joint Commission (2018) Quality check. https://www.qualitycheck.org/

  51. Cal Hospital Compare (2019) About. http://calhospitalcompare.org/about/

  52. National Quality Forum (2019) About us. http://www.qualityforum.org/About_NQF/

  53. Institute for Healthcare Improvement (2019) About us. http://www.ihi.org/about/Pages/default.aspx

  54. Healthgrades Operating Company (2019) Quality and transparency. https://www.healthgrades.com/quality/

  55. Association of American Medical Colleges (2001) Report V contemporary issues in medicine: quality of care, medical school objectives project. Washington, DC

    Google Scholar 

  56. Obeso V, Brown D, Aiyer M, et al (eds) (2017) Core EPAs for entering residency. Toolkits for the 13 Core EPAs. Association of American Medical Colleges, Washington, DC. https://www.aamc.org/initiatives/coreepas/publicationsandpresentations/

  57. Institute for Healthcare Improvement (2019) Open school. http://www.ihi.org/education/ihiopenschool/

  58. Institute for Health Care Improvement (1998) Knowledge domains for health professional students seeking competency in the continual improvement and innovation of health care. Boston. http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Publications/EightKnowledgeDomainsForHealthProfessionStudents.aspx

  59. Gould BE, Grey MR, Huntington CG et al (2002) Improving patient care outcomes by teaching quality improvement to medical students in community-based practices. Acad Med 77(10):1011–1018

    Article  Google Scholar 

  60. Swing SR (2007) The ACGME outcome project: retrospective and prospective. Med Teach 29(7):648–654. https://doi.org/10.1080/01421590701392903

    Article  PubMed  Google Scholar 

  61. American Board of Medical Specialties (2017) Steps toward initial certification and MOC. http://www.abms.org/board-certification/steps-toward-initial-certification-and-moc/. Accessed 7 Apr 2017

  62. Boonyasai RT, Windish DM, Chakraborti C et al (2007) Effectiveness of teaching quality improvement to clinicians. JAMA 298(9):1023–1037. https://doi.org/10.1001/jama.298.9.1023

    Article  CAS  PubMed  Google Scholar 

  63. Ogrinc G, Headrick LA, Mutha S et al (2003) A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from a literature review. Acad Med 78(7):748–756

    Article  Google Scholar 

  64. Varkey P, Reller MK, Smith A et al (2006) An experiential interdisciplinary quality improvement education initiative. Am J Med Qual 21(5):317–322. https://doi.org/10.1177/1062860606291136

    Article  PubMed  Google Scholar 

  65. Accreditation Council for Graduate Medical Education (2019) Clinical Learning Environment Review (CLER). https://acgme.org/What-We-Do/Initiatives/Clinical-Learning-Environment-Review-CLER

  66. Co JPT, Weiss KB, Koh NJ, Wagner R (2018) CLER National Report Findings 2018: Executive Summary. Accreditation Council for Graduate Medical Education, Chicago

    Google Scholar 

  67. Wong BM, Levinson W, Shojania KG (2012) Quality improvement in medical education: current state and future directions. Med Educ 46:107–119. https://doi.org/10.1111/j.1365-2923.2011.04154.x

    Article  PubMed  Google Scholar 

  68. American Board of Medical Specialties (2019) Board certification, assessed through a four-part framework. https://www.abms.org/board-certification/a-trusted-credential/assessed-through-a-four-part-framework/

  69. American Board of Medical Specialties (2019) About portfolio program. https://mocportfolioprogram.org/about-us/

  70. Accreditation Council for Continuing Medical Education (2007) ACCME policy updates. http://www.accme.org/sites/default/files/null/409_ACCME%20Policy%20Updates%202007_20070824.pdf

  71. Accreditation Council for Continuing Medical Education (2019) Accreditation criteria. http://www.accme.org/accreditation-rules/accreditation-criteria

  72. Accreditation Council for Continuing Medical Education (2019) CME in support of MOC. http://www.accme.org/cme-support-moc

  73. Accreditation Council for Continuing Medical Education (2015) ACCME 2015 Data Report. http://www.accme.org/publications/accme-2015-data-report. Accessed 7 April 2017

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Kfuri, A., Davis, N.L., Giardino, A.P. (2021). External Quality Improvement: Accreditation, Certification, and Education. In: Giardino, A., Riesenberg, L., Varkey, P. (eds) Medical Quality Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48080-6_10

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  • DOI: https://doi.org/10.1007/978-3-030-48080-6_10

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