Core Curriculum for Medical Quality Management

by American College of Medical Quality

• ISBN13: 9780763730611
• ISBN10: 0763730610
• Edition: 1st
• Format: Paperback
• Copyright: 2005-03-16
• Publisher: Jones & Bartlett

Summary

Core Curriculum for Medical Quality Management addresses the needs of physicians, medical students, and other health care professionals for current information about medical quality management, principles, methods, programs, systems, and experiences. This book presents a true "state-of-the-nation" assessment of medical quality management and highlights the need for training of physicians who will lead the medical quality movement in the 21st century. Each contributing author is a recognized leader in medical quality management. The reader should find this to be a highly readable basic text to acquire a sound initial working knowledge of medical quality management.

Table of Contents

About the American College Medical Quality	ix
Introduction
Alex R. Rodriguez, MD	xi
Acknowledgments	xvii
Contributors	xix
Chapter 1 Quality Management Principles and Practices	1	(68)
ARTHUR L. PELBERG, MD, MPA
Introduction	1	(1)
The Quality Management Movement to the Present	1	(4)
An Early Start	2	(1)
Clinical Quality Assurance	2	(1)
Conceptual Foundations of Quality Management	2	(1)
Autonomy of Professionals	2	(1)
The Parallel Industrial Quality Track	3	(1)
From Clinical Quality Management to Total Organization Quality Management	3	(1)
Malcolm Baldrige Awards	4	(1)
Information Systems Support	4	(1)
Institute of Medicine Reports and Other Studies	4	(1)
The Purpose and Philosophy of Quality Management	5	(51)
Methods and Procedures	8	(1)
Quality Management Plans and Work Plans	8	(2)
Levels of Inquiry and Quality Management	10	(1)
Baseline Assessment and Benchmarking	11	(5)
Quality Improvement Process Steps	16	(1)
Measurement Challenges	17	(7)
Information Systems Support: Indicators and Monitors	24	(4)
Methods and Tools	28	(16)
Outcomes Assessment	44	(2)
Integrated Approaches	46	(10)
Benefits and Outcomes of Quality Management	56	(1)
Organizational Supports and Obstructions	57	(3)
Support Components	57	(2)
Obstructions	59	(1)
Accrediting and Regulatory Oversight Organizations	60	(2)
Organizational Characteristics	60	(2)
Key Organizations	62	(1)
Summary	62	(3)
Web Sites for Health Care Quality	65	(1)
Appendix	65	(4)
Chapter 2 Utilization Management	69	(26)
ERIC Z. SILFEN, MD, MHSA and RALPH H ROSENBLUM, JR., DDS, MHA
Introduction	69	(1)
Development of Utilization Management	70	(3)
Background and Purpose	70	(1)
Developmental Milestones	71	(2)
Purpose and Perspective of Utilization Management	73	(1)
The Process of Utilization Management	74	(11)
Program Design and Work Plan	74	(11)
Outcomes and Benefits	85	(1)
Organizational Barriers	86	(2)
Accrediting and Regulatory Oversight Organizations	88	(2)
Utilization Review Accreditation Commission (URAC)	88	(1)
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)	89	(1)
National Committee on Quality Assurance (NCQA)	89	(1)
Summary	90	(5)
Chapter 3 Organization Design and Management	95	(28)
JAMES T. ZIEGENFUSS, JR., PHD
Introduction	95	(3)
Near Term History	96	(2)
Organizational Systems Thinking	98	(3)
Responsibilities and Competencies	101	(2)
Roles, Authority, and Power	103	(2)
Planning and Vision	105	(3)
Group Dynamics	108	(2)
Strategy Formulation and Implementation	110	(4)
Evaluation	114	(1)
Education through Feedback	115	(2)
Organization and Management Summary	117	(5)
Related Readings	122	(1)
Chapter 4 Economics, Finance, and Government in Medical Quality Management	123	(40)
DONALD FETTEROLF, MD, MBA and JOSEPH L. BRAUN, MD, JD, MBA
Introduction	123	(2)
Historical Perspective	125	(4)
Basic Concepts in Business and Economics	129	(17)
Economics	129	(3)
Accounting	132	(8)
Finance	140	(1)
Other General Business Principles	141	(5)
Making the Business Case for Medical Quality	146	(3)
The Role of Government in Medical Management and Quality	149	(4)
Health Care as a Public Good	153	(2)
Conclusion	155	(1)
Appendix A	156	(2)
Appendix B	158	(5)
Chapter 5 Medical Informatics and Information Systems: The Information Infrastructure Needed to Support Quality Measurement and Improvement	163	(24)
LOUIS H. DIAMOND, MB, CHB
Introduction	163	(1)
Development of an Information Infrastructure: Historical Background	164	(3)
The Purpose and Philosophy of an Information Infrastructure	167	(1)
Components of an Information Infrastructure for Quality Management	168	(14)
Data Sources	168	(1)
Data Definitions	169	(1)
Coding Classification Systems	170	(2)
Data Transmission	172	(1)
Data Storage and Analysis	173	(4)
Quality Measurement	177	(3)
Techniques for Reporting	180	(1)
Organizational Capacity	180	(2)
Evaluating an Information Infrastructure	182	(1)
Barriers to Development of a Health Information Infrastructure	182	(1)
A Case Study of Disease Management Interventions	183	(4)
Chapter 6 Legal and Ethical Issues in Medical Quality Management	187	(20)
JOSEPH A. MISLOVE, JD, MBA and JEFFREY ZALE, MD, MPH
Introduction to Part I, Legal Issues	187	(1)
Regulatory and Accreditation Requirements for Medical Quality Management	188	(1)
Risk Management Incentives to Conduct Medical Quality Management	188	(1)
Legal Responsibility for Conducting Medical Quality Management	189	(1)
Legal Protections for Conducting Peer Review: Confidentiality and Immunity	190	(6)
Confidentiality of Peer Review Proceedings	191	(1)
Immunity of Peer Reviewers	192	(4)
Conclusion to Part I: Legal Issues	196	(1)
Introduction to Part II: Ethical Issues	196	(1)
What Is Medical Ethics?	197	(1)
The Relevance of Medical Ethics to Medical Professionals	198	(1)
A Short History of Ethical Thought	198	(1)
Ethical Principles in Medical Care	199	(2)
A Three-Step Approach to Ethical Analysis	201	(1)
Common Ethical Dilemmas	202	(1)
Ethics Committees	202	(1)
An Ethical Dilemma Case: The Right to Die	203	(4)
Index	207