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.
Zhou
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Tufts Health Plan, Boston, MA, USA. qi_zhou@tufts-health.com
Mickey
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Lancaster
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Epstein
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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