Scheme Accreditation Research Articles

National health insurance accreditation pattern among private healthcare providers in Ghana

BackgroundHealthcare providers’ accreditation is one of the standard means of assuring quality services. This paper examines the pattern of National Health Insurance Scheme accreditation results among private healthcare providers in Ghana.MethodsA cross-sectional quantitative analysis of administrative data from seven National Health Insurance Scheme healthcare provider accreditation surveys over the 2009–2012 period. Data on private healthcare providers that applied for formal accreditation between the study period were retrieved from the NHIS accreditation database using a checklist. Proportions were used to examine pattern of private healthcare provider accreditation results by region, type of care provider, and grade.ResultsOverall, 1600 healthcare providers applied for accreditation over the study years, of which 1252 (78%) passed and were accredited. Majority of healthcare providers that passed the healthcare facility assessment were in Ashanti, Greater Accra, and Western regions, and were significantly higher than those in the other regions. Among the healthcare providers that passed the assessment, pharmacies (22%) and clinics (18%) constituted the largest groups, and were significantly higher than the other types of healthcare providers. Similarly, among those that passed, majority (62%) obtained grade C and D, representing a score of 50–59% and 60–69%, respectively, and were significantly higher than those that obtained the top three grades of A+ (90–100%), A (80–89%) and B (70–79%).ConclusionsMajority of healthcare providers accredited to provide services to the insured are concentrated in three regions of the country, and are mainly pharmacies and clinics. Moreover, substantial proportion of the healthcare providers obtain average scores of the healthcare facility assessment, an indication that these care providers fall below the National Health Insurance Scheme applicable-predetermined standards.

Continuing Medical Education in six European countries: A comparative analysis

We examined Continuing Medical Education (CME) systems in a sample of six EU countries: Austria, Belgium, France, Italy, Norway, and the UK. The aim of this comparative study was to assess the main country-specific institutional settings applied by governments. A common scheme of analysis was applied to investigate the following variables: (i) CME institutional framework; (ii) benefits and/or penalties to participants; (iii) types of CME activities and system of credits; (iv) accreditation of CME providers and events; (v) CME funding and sponsorship. The analysis involved reviewing the literature on CME policy and interviewing a selected panel of local experts in each country (at least one public manager, one representative of medical associations and one pharmaceutical manager). CME is formally compulsory in Austria, France, Italy and the UK, although no sanctions are enforced against non-compliant physicians in practice. The only two countries that offer financial incentives to enhance CME participation are Belgium and Norway, although limited to specific categories of physicians. Formal accreditation of CME providers is required in Austria, France and Italy, while in the other three countries accreditation is focused on activities. Private sponsorship is allowed in all countries but Norway, although within certain limits. This comparative exercise provides an overview of the CME policies adopted by six EU countries to regulate both demand and supply. The substantial variability in the organization and accreditation of schemes indicates that much could be done to improve effectiveness. Although further analysis is needed to assess the results of these policies in practice, lessons drawn from this study may help clarify the weaknesses and strengths of single domestic policies in the perspective of pan-European CME harmonization.

CPA assessment – the regional assessors’ experience

Many individuals within Laboratory Medicine will be unaware that CPA conducts assessments to two different sets of CPA Standards. There are the Standards for the Medical Laboratory and the Standards for EQA Schemes in Laboratory Medicine. The style and format of both sets of standards is very similar with each being presented in eight sections A – H.The EQA standards are almost identical to the laboratory standards with the exception of the E.F and G standards which are specific to EQA schemes. There are approximately 40 EQA Schemes registered with CPA compared with almost 2 500 laboratories. These EQA schemes vary from very large national/international schemes with numerous analytes to small interpretive schemes run by one individual with a personal interest in that specific subject.The large schemes usually come under the UKNEQAS consortia banner and due to their size and configuration do not present undue problems in the assessment process.Smaller interpretive EQA schemes present a challenge both for the scheme and CPA in gaining accreditation. These schemes are usually within the discipline of Histopathology and are regarded as educational rather than proficiency testing schemes. Very frequently, the scheme is organized by a single individual with a collection of microscope slides, storage facilities for the slides and a computer.This presents the Scheme Organizer with great difficulty in complying with the Quality Management System requirements of the CPA Standards. There are a number of models which can be applied in order to satisfy the requirement of the Quality Management System, but ultimately it must be recognized that in some circumstances it is not possible to accredit these small schemes.The NHSCSP Gynae Cytology EQA Scheme is probably the largest EQA scheme within the UK, in respect of the number of participants and the number of staff supporting the scheme. Scheme Management decided that all nine regions of England would apply for accreditation under one CPA Reference Number. This process meant that the scheme would be assessed as a Managed Pathology Network. This is unique in terms of EQA schemes and presented a number of problems not previously encountered in EQA scheme accreditation. This decision meant that all nine regions must comply with a single Quality Management System and other CPA standards whilst allowing flexibility within the system for each region to facilitate the assessment process specific to their user's requirements.The process worked in a satisfactory manner and the overall outcome was not dissimilar to that of other large EQA schemes.The assessment to the current EQA Standards only commenced in April 2006 whilst the Standards for Medical Laboratories commenced in 2003, and it is perhaps not surprising to find that the principal non‐conformities are related to the Quality Management System. This parallels the findings encountered in laboratory accreditation.There is an ongoing educational process for Scheme Management and the Facilitators in each region in how to comply fully with the standards and a commitment to quality improvement which ultimately is beneficial to the participant's of the scheme and to patient safety.

External Quality Assessment Schemes: need for recognised requirements

Programs for Accreditation of clinical laboratories consider participation in External Quality Assessment Schemes (EQAS) a key element in the evaluation of testing procedures and improving them. One of the main functions of EQAS is to assess whether laboratories perform tests competently. It is therefore of utmost importance for laboratories to participate in EQAS that are in line with formally recognised requirements. Specific proposals have been made on how to design and execute EQAS by International Working Groups, but there seems to be no consensus on the best strategies to use and quality specifications to set out. The Clinical Pathology Accreditation (CPA) Program for EQA Scheme Accreditation (CPA-EQA) is the only program in Europe to provide a formal recognition of the quality of EQAS activities. The present paper reports on the experience of the Centre of Biomedical Research which is following an accreditation process for their own schemes in line with the CPA-EQA program and a proposal to set requirements that Italian schemes must follow to be recognised as valid and effective.

External quality assurance programmes in medical laboratories

Medical laboratories have a long tradition of external quality assessment. Starting from pure quality control of laboratory performances, most schemes have evolved to a powerful tool for improving quality of clinical outcome of results. External quality assurance in medical laboratories not only includes laboratory performance evaluation, but also evaluation of method performance, post-marked vigilance, training and help. In the future, the quality of programmes must further be improved by accreditation of schemes and by using electronic data interchange.

Quality assurance in clinical chemistry laboratories in the UK

Since the mid-1960s quality assurance in clinical chemistry has progressed from a need to define and improve precision and accuracy in analytical test procedures to an all-embracing process of assuring that the whole process of pre-analytical, analytical and post-analytical phases of handling patient samples is managed effectively and efficiently. Automated and computer-controlled equipment has reduced many of the analytical errors, in particular in imprecision, that were present in manual analysis. New management techniques have been developed to control the quality and appropriateness of results. Developments in internal quality control and external quality assessment procedures have enabled laboratories to continually improve the quality of assays. Laboratory accreditation and external quality assessment scheme accreditation have ensured that peer review and peer pressure have been applied to both laboratory and external quality assessment scheme performance. As the NHS reviews its priorities and places more emphasis on primary care provider demands, hospital laboratories will of necessity assist with near patient testing outside the laboratory. This will provide new challenges to the quality of the service provided.

The European Eco-Management and Audit Scheme Accreditation - an overview

Environmental quality is still deteriorating in the EU and worldwide despite all the Directives and Regulations in this field over the past 20 years. The European Community has devised a new approach to this problem with the introduction of the Eco-Management and Audit Scheme Regulation. This Regulation provides industry with an opportunity to demonstrate that it can achieve continuous improvement in its environmental performance through a voluntary scheme which is not based on the traditional command and control mechanisms of Directives. This paper gives an overview of the steps involved in implementing the European Eco-Management and Audit Scheme and the role of accreditation in supporting the scheme.

Medical audit in a Scottish psychiatric service

Psychiatry is unique in already being subject to statutory external audit through regular visits to psychiatric hospitals and units by the Hospital Advisory Services and Mental Health and Mental Welfare Commissions. These organisations do comment on aspects of the standard and quality of care. Reports of their findings undoubtedly facilitate change. By their programme of repeated visits they are in a position to observe the implementation and outcome of altered patterns of practice brought about by their reports. The Codes of Practice being prepared by the Mental Health Commission (England and Wales) and Mental Welfare Commission (Scotland) is another step that will significantly influence clinical practice. Finally, the Royal College of Psychiatrists' postgraduate training scheme accreditation exercise, like those of the other Royal Colleges and Faculties, has had an impact on quality of clinical care through its policy of gradually increasing the standard of postgraduate clinical training requirements. Locally based audit clearly complements these external exercises and local psychiatric services are now expected to organise systems of regular internal audit as are the other clinical disciplines (Department of Health, 1989).