I. Promoting Quality
a. Defining quality and encouraging quality – pgs 10-26, 32-35
i. Quality of care is the degree to which health services for individs and populations increase the likelihood of desired health outcomes and are consistent w/current professional knowledge
ii. Three ways to measure quality:
1. Structure – relatively stable characteristics of providers of care, tools and resources at their disposal and of the physical and organizational settings in which they work, how adequate is the equipment, infrastructure and resources
a. Structural characteristics of the setting in which care takes place have a propensity to influence the progress of care so that its quality is diminished or enhanced. Similarly, changes in the process of care, including variations in its quality will influence the effect of care on health status, broadly defined.
2. Process – the whole thing, follow-up, interaction
3. Outcome – change in patient’s current and future health status that can be attributed to antecedent health care, focusing on the result, there was a bad result
iii. Two areas of Quality:
1. Technical – application of the science and technology of medicine and of the other health sciences to the management of a health problem “science of medicine”
2. Interpersonal – management of social and psychological interaction b/t client and practitioner “art of medicine”
iv. QA mechanisms:
1. Govn’t Payor Certification – outside checks on quality
2. JACHO Accreditation (Joint Commission of American Health Organization) – doctors rated themselves
3. Professional Licensing Boards – structural, doctors rating themselves
4. Report Cards – outside checks on quality, outcomes, if you don’t understand the info you’re getting you may misinterpret the data
a. BJC example – has a high infant mortality rate but that’s b/c they get sicker babies
5. Malpractice suits – outcomes, doctors rating themselves don’t give incentive to prevent things from happening b/c this doesn’t come about until bad thing’s already happened
6. Peer Review – doctors rated themselves
7. Risk Management – doctors rating themselves
8. Board Certification – doctors rating themselves
9. Clinical guidelines
10.OSHA
11.Criminal Law
12.Utilization Review – outside checks on quality
b. Board Certification – like passing the bar,
i. If you want to be “Board Certified” you apply to a specialized society board
ii. That Board administers its own test and you get a certificate
c. Professional Licensure/Disciplinary Actions – pgs 92-125
i. State law controls licensure under its police power
ii. Licensing Statutes govern entry and disciplinary actions against licensed health care professionals
iii. Statutes implemented by Boards that operate as state entities and are dominated by members of the profession (doctors)
iv. Licensure is often described as system of self-regulation even though the Boards act as state agencies
cticing in AND experts did not examine the patients or their medical records or treat chronic pain
c. Defendant was investigated b/c of amts of medication she prescribed
d. After this case Licensure people stopped investigating people based on amts of medication prescribed (b/c doctors don’t want to lose their licenses so that sort of monitoring may have a chilling effect on prescribing medicine) AND Board must bring in experts from defendant doctor’s field
e. Judicial Standard of Review – A Board of Medicine must give substantial weight to a hearing officer’s findings before supplanting the findings and revoking a license to practice medicine. So long as an administrative officer bases findings on competent substantial evidence, there are no grounds to set aside the officer’s findings. In this case, the hearing officer weighed the detailed and extensive testimony of Dr. (P) against the opinions of two experts who had not so much as read a single patient file. After examining federal guidelines, subsequent legislation in the state, and all the evidence in the proceeding, the hearing officer made a reasonable recommendation to the Board of Medicine (D) which it rejected.
