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Related Experiment Videos

Promoting quality through managed care.

R L Coleman1

  • 1University of Connecticut, Farmington.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|January 1, 1992
PubMed
Summary
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Managed care organizations can improve quality and control costs using quality management and practice guidelines. These strategies promote adherence to standards, enhance clinical decision-making, and reduce practice variations for better patient care.

Area of Science:

  • Health Services Research
  • Quality Improvement Science

Background:

  • Managed care organizations (MCOs) face dual pressures to enhance healthcare quality and manage costs effectively.
  • Organized systems of care require robust strategies to ensure adherence to quality and appropriateness standards.

Purpose of the Study:

  • To explore how quality management approaches and practice guidelines can be utilized by MCOs.
  • To examine the role of these tools in promoting quality care and controlling costs within organized systems of care.

Main Methods:

  • Focus on systems of care as a component of the quality improvement process.
  • Development and utilization of practice guidelines with varying levels of explicitness.
  • Integration of risk management, quality assurance, and quality improvement techniques.

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Main Results:

  • Quality management approaches and practice guidelines enable MCOs to promote quality care.
  • These tools aid in controlling healthcare costs.
  • Systems of care focus enhances the quality improvement process.
  • Guidelines help reduce undesirable variation in practice patterns and prevent problems.

Conclusions:

  • Implementing quality management and practice guidelines enhances clinical decision-making effectiveness.
  • MCOs can productively collaborate with physicians to promote quality through these mechanisms.
  • A systems-of-care approach is integral to successful quality improvement initiatives.