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A performance-based quality evaluation system for preferred provider organizations.
M McGuirk-Porell1, G A Goldberg, D Goldin
1Private HealthCare Systems Limited, Lexington, MA 02173.
QRB. Quality Review Bulletin
|November 1, 1991
Summary
This program uses quality indicators to monitor preferred provider organization (PPO) standards across patient care components. It aims to improve care by addressing practice deviations through organizational strategies and physician communication.
Area of Science:
- Healthcare Management
- Quality Improvement
- Health Services Research
Background:
- Preferred Provider Organizations (PPOs) require robust quality evaluation programs.
- Monitoring patient care across diverse settings is crucial for effective healthcare delivery.
Purpose of the Study:
- To describe a performance-based quality evaluation program for a nationwide PPO.
- To outline strategies for quality improvement and addressing practice deviations.
Main Methods:
- Utilized indicators to monitor four components of patient care: administrative efficiency, patient satisfaction, medical practice standards, and clinical outcomes.
- Implemented indirect organizational strategies and direct communication for quality improvement.
Main Results:
- The program effectively uses available data to monitor care quality over time.
- Demonstrated the ability to track individual patient care across various settings (hospitals, physician offices).
Conclusions:
- The program offers a model for evaluating and improving care quality in PPO networks.
- Its strengths include data utilization, adaptability to loosely connected provider networks, and comprehensive patient care monitoring.