DM3 Outcomes Research in Medication Use: HCFA'S Health Care Quality Improvement Program

Abstract

Outcomes research can be used to great advantage in health care quality improvement efforts. The Health Care Financing Administration (HCFA) has reengineered the peer review program to follow this approach. The old style of peer review largely relied upon case review, in search of the “bad apple,” a Quality Assurance (QA) approach. HCFA recognized that this approach created adversarial relationships and did little to improve the quality of health care. The new approach to health care quality improvement uses the principles of Continuous Quality Improvement (CQI) and modern methods of Outcomes Research to improve systems of care. HCFA calls this the Health Care Quality Improvement Program (HCQIP). Quality Improvement Organizations (QIOs) work in all US states and territories to improve health care for Medicare beneficiaries. These QIOs (formerly called PROs or Peer Review Organizations) collaborate with providers of health services, educational institutions, departments of health, consumer groups, and industry in projects designed to improve processes and outcomes of care in selected disease states and clinical problem areas. Many of these projects focus on medication use issues. Examples of these projects will be presented to the audience. Participants will be made aware of opportunities to collaborate on quality improvement projects at the state, regional, and national levels. This workshop is designed for individuals interested in improving health care through Outcomes Research and Continuous Quality Improvement.