Essay Sample: Quality Improvement Organizations in the US Health Care

Published: 2022-09-29
Essay Sample: Quality Improvement Organizations in the US Health Care
Type of paper:  Essay
Categories:  Healthcare
Pages: 7
Wordcount: 1727 words
15 min read

Health care in the United States has undergone a lot of major changes; it has evolved and with the entry of other organizations that look at the quality of the health care more improvements are still being done. The Quality Improvements Program is a very vital program in the US health care structure. It is a federal program that has the main aim of improving health care provision, especially for Medicare beneficiaries. It is also an integral part of the Department of Health and Human Services (DHHS) in the US. The QIO program ensures that there is the provision of better care to the citizens and that this care is provided at an affordable rate that the citizens can access. The Quality Improvement Organizations have a mandate to improve the effectiveness of the provision of health care services which will see an efficiency increase in the health provision (Cebul, Rebitzer, Taylor & Votruba, 2008). Also, the program ensures the economy is good and also the services that beneficiaries of Medicare get are quality and economical.

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The Quality Improvement Program has the following key functions: to advance the value of health care that is received by beneficiaries of Medicare, to help in protecting the integrity of the Medicare Trust Fund, this is done by ensuring that whatever that is paid by Medicare is reasonable and necessary and that it has been provided to the person that deserves it (Cebul, Rebitzer, Taylor & Votruba, 2008). They also protect the beneficiaries and this they do by addressing individual complaints to the related providers. All this they do to make sure that they protect the recipients of the Medicare from exploitation and that whatever that they receive is quality and economical (Cebul, Rebitzer, Taylor & Votruba, 2008).

One of the Quality Improvement Organizations (QIOs) in the US includes the Ambulatory Care Quality Alliance (AQA) whose main mandate is to develop the worth in the clinics as well as help consumers in decision-making. The AQA was created by the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), America's Health Insurance Plans (AHIP), and Agency for Healthcare Research and Quality (AHRQ) (Peden, 2015). The body is made up of stakeholders from the clinicians, clients, buyers, health policies and many others. It was convened in September 2004, and the main mission was to increase health care quality and patient well-being. This process was done by having a collaborative process whereby all the stakeholders agreed on a strategy that would be used to measure the performance at the level of physicians. This would see the stakeholders get valuable information to have good choices and outcomes. AQA was convened to address the challenges that faced the health care system (Cebul, Rebitzer, Taylor & Votruba, 2008). There was a need to have data that would identify the areas that needed to be improved. Providing timely data to the physicians would mean that they would apply corrective measures in good time. There was a need for a uniform approach in collecting the data that would help in the health care. Some of the challenges that were to be addressed by this unit were, for instance, there was a burden that physicians, clinicians, and health insurance plans had especially handling different data that wasn't consistent. This process made them shift their focus away from quality and efficiency in the health care system.

Another problem was brought as a result of this inconsistency of the data which led to the creation of confusion among the consumers. This inconsistency in data brought in another problem, the system could not have collective efforts that would enable them make consistent and efficient decisions and come up with programs that were suited for all employees. Every group had their data which was different from the others. This meant that for decisions, every group was to make their own. All these problems meant that there was a need to harmonize the data so they could work as one. Without uniform data, there was no way the system could work in one direction. There was need of a uniform approach regarding quality and performance measures. This would create a uniform approach in using limited resources and a better way of establishing quality and efficiency. In the AQA meetings, some stakeholders usually take part, and these include stakeholders like physicians, hospitals, and other professionals from the health care sector. We also have private sector employers, public purchasers, health insurance plans and other accredited organizations.

The second example is the Agency for Healthcare Research and Quality (AHRQ), which is an organization of the US administration and is part of the Department of Health & Human Services and its core mandate, is to back inquiry to advance the quality of health care. The agency uses a system of indicators of quality to determine the standards of quality health care (Peden, 2015). They use these indicators to ascertain whether providers meet the set standards. The indicators that they use are as follows; Prevention Quality Indicator (PQI) which is used to classify some hospital admissions which in one way or the other could have been eluded by providing developed quality casualty care. This is usually applied to patients who experience a reoccurrence of appointments. The next indicator is the In-patient Quality Indicator (IQI) that looks at the quality of the care offered exclusively to a hospital. The third one is the Patient Safety Indicators (PSI) that looks at the value of care that patients receive in a hospital. Their main aim is to look at the mortalities that could have been avoided like mortalities caused by using inappropriate machines. The final one is the Pediatric Quality Indicators concerned with mostly the quality of care specifically given to the pediatric population.

We also have the Institute of Medicine (IOM) which was established in 1970 and is affiliated with the National Academies of Science. It is a non-profit organization whose key objective is to provide leadership on health care. The IOM gives quality and excellent sources for leaders to help them gain access to the current research in health care. It helps them look for the problems that are affecting the US health care system and in turn offer the best solutions for the problems (Peden, 2015). They deliver evidence-based study, and they give commendations for the community health and science policy. They are mandated with determining the quality of the health care system. Their mission is to advance and disseminate knowledge on health care to help improve human health. Their information is usually objective, timely, and authoritative. This information is given to the government, the corporate sector, the professionals, and the public.

The National Committee for Quality Assurance (NCQA), private not for profit association, is tasked with improving the quality of health care. They improve the value by assessing and reporting on the status of managed care and other types of health care organizations in the United States (NCQA, 2011). Their stamp signifies quality for consumers and employers (NCQA, 2011). They look at whether an organization is well managed and that the care that is delivered is of the maximum quality as per the guidelines. They develop the HEDIS (Healthcare Effectiveness Data and Information Set) for analyzing the quality in the health care. The NCQA is governed by a board of directors. The Board is made up of employers, quality experts, regulators, consumers, and health plans. Their main agenda is usually to msake sure that the health quality given is of high quality. And this also includes the health care given by private providers. Normally, NCQA has two units, and that is one tasked with doing accreditation, and the other unit deals with performance measurement that they do across the health care providers all over the country. To do their work better they also make sure that they have certified other programs that are related to health care and that includes giving physician organizations, disease management programs, and other programs in health care their certification. This is in line to make sure that health care is improved and offered well to the people.

Another important QIO in the US health care system is the Institute for Healthcare Improvement (IHI). The IHI is a not-for-profit organization, and it is also autonomous. It is based in Boston, Massachusetts and is a leader in driving the results of health and health care improvement. Their mission is to make sure that everyone gets the best care and health at all times. They work out to improve the services offered in the health care system. Their work is anchored in key areas like Improvement capability which ensures that the health care is improved in the communities. They also have Person-and Family-centered care which primarily deals with putting the patient and the family as a core in their mandates. This they do by empowering them and making them their partners to work together. Another area is patient safety which makes sure that the safety of the consumers is taken care of by creating an environment that is safer and reducing harm and preventable mortality. They make sure that they reduce the number of mortalities that happen as a result of preventable situations, for instance, use of outdated machines in the hospitals. They also carry out quality, cost and value programs. This is to ensure that the health care is affordable to all the people and that it has sustainability and this they do by making sure that the quality is improved and met. By doing so, they are creating a system that is both affordable and efficient for all people who rely on it. Lastly, they have Triple Aim for Populations where they apply approaches that will see an improvement in care offered, the population health is improved, and the costs per capita are greatly reduced. They collaborate with professionals and this they do throughout the world.


Cebul, R. D., Rebitzer, J. B., Taylor, L. J., & Votruba, M. E. (2008). Organizational fragmentation and care quality in the US healthcare system. Journal of Economic Perspectives, 22(4), 93-113.

Peden, A. (2015). Comparative health information management. Nelson Education.

Casey, M., Prasad, S., Distel, E., & Evenson, A. (2015). Evidence-Based Programs and Strategies for Reducing Healthcare-Associated Infections in Critical Access Hospitals.

National Committee for Quality Assurance (NCQA). Content last reviewed July 2011. Agency for Healthcare Research and Quality, Rockville, MD.

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