Key Components Of Quality Assurance

Introduction The health care system is plagued with access disparities, utilization management issues, and inequality of care. For years health care compensation was quantity driven; however, current state is all about quality of care. The million dollar question is “How do we improve our health care delivery system?” Efforts to improve patient outcomes, access to care, equality of care, and better management of health care costs are ongoing. In fact, the Institute of Medicine (IOM) aims for improvement in safe, effective, timely, patient-centered, efficient, and equitable health care (Kongstvedt, 2013, pg 316). Establishing standards, guidelines and outcome measurements is the premise of quality control. This paper will discuss the key components …show more content…
Additionally, Carefoote (1998) describes quality assurance as having emphasis on outliers and redirecting them to align with the norm. The key components of the quality assurance model are: structure, process, outcome, peer review and appropriateness evaluation (Kongstvedt, …show more content…
Appropriateness evaluation targets areas of potential overutilization. Costly procedures, for example, are often selected for appropriateness review. Additionally, appropriateness evaluation monitors services provided by the MCO. It is designed to identify if services are timely, necessary and of benefit (Kongstvedt, 2013). Furthermore, appropriateness evaluation is aligned with the IOM’s aims of effective and timely care delivery (Kongstvedt, 2013, pg 317).
Quality Management
Quality management is an expansion of quality assurance. Quality management and quality assurance are both founded on the principles developed by Avedias Donabedian: structure, process, and outcome (Kongstvedt, 2013). Our text refers to quality management as a continuous improvement process composed of eight steps.
A unique step in quality management is the incorporation of the voice of the customer. According to Kongstvedt (2013) a customer may be internal, external, or a supplier. Vital functions of a quality management program include understanding customer needs and identifying processes and outcomes that meet customer needs. A successful MCO should meet the expectations of the customer. Otherwise, customers complain and/or go elsewhere for services. MCOs are charged with improving access to care and providing appropriate care (Kongstvedt, 2013). Quality management programs help to identify quality issues and