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Suggested Citation: "Contents." Institute of Medicine. 1990. Medicare: A Strategy for Quality Assurance, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/1547.

	PREFACE	ix
	INTRODUCTION TO THE STUDY AND THIS REPORT	xiii
	SUMMARY	1
1	HEALTH, HEALTH CARE, AND QUALITY OF CARE	19
	Defining Quality of Health Care,	20
	Health and Health Care in the United States,	25
	Quality of Health Care as a Public Policy Issue,	31
	Summary,	37
2	CONCEPTS OF ASSESSING, ASSURING, AND IMPROVING QUALITY	45
	Quality Assessment, Quality Assurance, and Quality Improvement,	45
	Criteria for Judging an Effective Quality Assurance Program,	49
	Quality Assurance Conceptual Models,	52
	Traditional and Continuous Improvement Models Compared,	62
	Summary,	64
3	THE ELDERLY POPULATION	69
	Size and Growth of the Elderly Population,	69
	Sociodemographic Characteristics,	71
	Economics of Aging,	75
	Use of the Health Care System,	79
	Health Status,	85
	Summary,	91

Page vi Cite Bookmark

Suggested Citation: "Contents." Institute of Medicine. 1990. Medicare: A Strategy for Quality Assurance, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/1547.

4	THE MEDICARE PROGRAM	96
	Structure, Eligibility, and Benefit Coverage of the Medicare Program,	97
	Administration and Financing of the Medicare Program,	102
	Expenditures of the Medicare Program,	104
	The Prospective Payment System (PPS),	108
	Quality Assurance in Medicare,	110
	Summary,	111
	Appendix A The Medicare Catastrophic Coverage Act of 1988,	114
	Appendix B The Medicare Decision Support System,	117
5	HOSPITAL CONDITIONS OF PARTICIPATION IN MEDICARE	119
	Standards and Conditions,	120
	Inspection and Enforcement,	128
	Federal Government’s Roles and Responsibilities,	131
	Conclusions,	132
	Summary,	134
6	FEDERAL QUALITY ASSURANCE PROGRAMS FOR MEDICARE	138
	Experimental Medical Care Review Organizations,	139
	Professional Standards Review Organizations,	139
	Utilization and Quality Control Peer Review Organizations (PROs),	147
	Controversial or Problematic Aspects of the PRO Program,	182
	Conclusions About the PRO Program,	195
	Summary,	199
7	QUALITY PROBLEMS AND THE BURDENS OF HARM	207
	Introduction,	207
	Evidence of Problems in Technical Quality of Care,	211
	Evidence of Overuse,	220
	Evidence of Underuse,	225
	Summary,	230
8	SETTINGS OF CARE AND PAYMENT SYSTEM ISSUES FOR QUALITY ASSURANCE	238
	Settings,	238
	Payment Systems,	254
	Other Setting and System Factors,	258
	Summary,	259

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Suggested Citation: "Contents." Institute of Medicine. 1990. Medicare: A Strategy for Quality Assurance, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/1547.

9	METHODS OF QUALITY ASSESSMENT AND ASSURANCE	265
	Introduction,	265
	Prevention of Problems,	267
	Detection of Problems,	274
	Factors that Impede or Enhance the Effectiveness of Quality Interventions to Correct Problems,	289
	Summary,	297
10	CRITICAL ATTRIBUTES OF QUALITY-OF-CARE CRITERIA AND STANDARDS	303
	Types of Criteria Sets,	304
	Effect of the Type and Use of Criteria on Specification of Desirable Attributes,	309
	General Attributes of Criteria Sets,	310
	Differences Among Key Attributes for Different Criteria Sets,	319
	Methods and Strategies for Developing Quality-of-Care Criteria,	323
	Other Issues,	325
	Summary,	328
	Appendix A Criteria-Setting Expert Panel Activity,	334
11	NEEDS FOR FUTURE RESEARCH AND CAPACITY BUILDING	343
	Research Needs,	344
	Capacity Building,	360
	Funding Issues,	363
	Summary,	363
12	RECOMMENDATIONS AND A STRATEGY FOR QUALITY REVIEW AND ASSURANCE IN MEDICARE	368
	Findings and Conclusions,	369
	Recommendations,	375
	Organizational and Operational Features of the Medicare Program to Assure Quality,	387
	Responsibilities and Tasks of the MPAQ,	394
	Responsibilities and Tasks of the MQROs,	400
	Implementation Strategy and Phases,	412
	Summary,	419
	ACKNOWLEDGMENTS	422
	INDEX	427

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Suggested Citation: "Contents." Institute of Medicine. 1990. Medicare: A Strategy for Quality Assurance, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/1547.

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Medicare: A Strategy for Quality Assurance, Volume I (1990)

Chapter: Contents

Contents

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Medicare: A Strategy for Quality Assurance, Volume I (1990)

Chapter: Contents

Contents