quality healthcare

Quality and Performance Improvement in Healthcare: Theory, Practice, and Management Sixth Edition

Chapter 1

Introduction and History of Performance Improvement

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Learning Objectives

Trace the historical events that have contributed to modern performance improvement programs

Identify the key legislation that has influenced healthcare quality initiatives

Describe the key individuals and organizations that have shaped the theory and developed models for use in performance improvement activities

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Early Quality Improvement Efforts

Mid 1700s ‒ Pennsylvania Hospital becomes the model for the organization and development of hospitals

1760 ‒ New York State begins the practice of medical licensure

1771 ‒ New Jersey begins the practice of medical licensure

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1800s

1837 – Massachusetts General Hospital sets limitations on clinical practice in the first granting of clinical privileges

1853 – Massachusetts General establishes the first disease and procedure index by classifying patient disposition

Mid-1800s – Medical licensure is deemed undemocratic and is stopped

1872 – New England Hospital for Women and Children organizes a general training school for nurses.

1874 – AMA encourages the creation of independent state licensing boards.

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1900s

1903 – North Carolina passes the first nurse registration bill in the US

1910 – Flexner Report indicates unacceptable variation in medical school curricula

1917 – ACS establishes the Hospital Standardization program

1920 – Most medical colleges meet rigorous academic standards and are approved by the Association of American Medical Colleges.

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1900s (cont’d)

1946 – Hill-Burton Act established funding to build new hospitals

1952 – Joint Commission of Accreditation of Hospitals was formed

1965 – Public Law 89-97 establishes Medicare and Medicaid

1972 – Local peer review organizations are formed

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1900s (cont’d)

1980s – PPS is established, state and regional peer review organizations contract with HCFA

1990s – JCAH becomes JCAHO. Deming’s TQM philosophy begins to spread in US healthcare. JCAHO integrates quality improvement into the accreditation process.

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2000s

2001 – Ambulatory payment classification system is initiated

2002 – HCFA becomes the Center of Medicare and Medicaid Services (CMS)

2003 – JCAHO implements the National Patient Safety Goals

2005 – JCAHO begins unannounced and tracer methodology surveys

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2000s (cont’d)

2007 JCAHO renames itself to The Joint Commission

2008 Medicare-Severity DRGs are implemented

2009 HITECH Legislation is passed

2010 Affordable Care Act is passed

2015 ICD-10-CM and ICD-10-PCS scheduled for implementation

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