A quality measurement framework for managed care organizations.
This article presents a framework for a quality measurement system and its corresponding principles for quality improvement within a managed care environment. The quality measurement system comprises four modes: quality assessment, comparison, improvement, and system evaluation. If these modes are to be effective, the measurement system must incorporate the following five principles: (a) maintain and continually improve the data systems, (b) develop and utilize sound methodology and valid indicators, (c) build a competent measurement team, (d) develop effective strategies for implementation, and (e) protect member confidentiality. This model is helpful in the ongoing development and testing of new measurement systems.
Tufts Health Plan, Boston, MA, USA. qi_zhou@tufts-health.com
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D001900:Boston; D003219:Confidentiality; D003628:Database Management Systems; D017408:Guidelines as Topic; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards*; D017146:Models, Organizational; D020380:Needs Assessment; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D015397:Program Evaluation / Q000379:methods; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D017749:Total Quality Management / Q000379:methods