Emerging Themes in Efforts to Improve the Quality of Health Care: Overview

Abstract

Conference-at-a-Glance Background The Health Care Financing Administration (HCFA), through its Peer Review Organizations (PROs), is responsible for monitoring and ensuring the quality of care provided to recipients of Medicare. The PROs are required to identify and rectify quality problems at the local physician and hospital levels. Because research has shown that changes in medicine are complicated, multifaceted, and difficult to achieve, the success of PROs in effecting positive change depends on their capacity to understand and influence complex variables. Conference presenters and participants This conference, originally titled Effecting Change in Physician Practice: Moraine Institute Diffusion/Dissemination Conference, held in Kansas City, Missouri, September 26-27, 1995, following the PROs' annual professional association meeting, was intended to both (1) describe the social, professional, and organizational factors affecting practice change and (2) give the faculty of nationally recognized experts feedback on PRO efforts to improve medical practice. The presenters of the 13 papers adapted for this issue are scholars specializing in medical sociology, communication, public health, health policy, and organizational behavior; representatives of HCFA, the Wisconsin PRO, the National Institutes of Health (NIH) Office of Medical Applications Research (the NIH Consensus Development Program), and the Joint Commission on Accreditation of Healthcare Organizations; and directors of cancer prevention and management projects carried out at academic institutions and in the community with the support of NIH's National Cancer Institute. The works cited in their papers are consolidated in the references at the end of the conference feature. The conference attendees were primarily physicians holding positions as medical directors and/or clinical coordinators and chief executive officers of 25 PROs and as medical officers at HCFA. They are responsible for developing medical quality improvement projects in their local regions with the collaboration and cooperation of health care providers. Issues and conclusions Four breakout sessions enabled the faculty and PRO physicians to compare theory and practice. Their discussions, reported in this issue, raised three specific concerns about PROs' accountability and responsibility: (1) determining how to intervene most effectively in a complex health care system; (2) assuring patients, the U.S. Congress, and society that equitable, high-quality, cost-effective medical care is being provided to all beneficiaries; and (3) improving health status. The questions that remain to be answered are ■Who is accountable—will health professionals be empowered to improve performance or will this task fall to health care administrators? ■To whom are they accountable—the public represented by professional bodies and Congress in the model that gave rise to PROs or the public represented by the market decisions of various health care buyers? ■Who is accountable for the health of the population as a whole?