Einstein/Montefiore Department of Medicine

Quality Improvement Terms

Most quality improvement approaches in medicine are derived from industrial practices used in manufacturing and aviation. These practices and their corresponding terms have continued to evolve.

Common quality improvement terms include the following:

Quality Assurance (QA): QA has traditionally focused on a few individuals' detecting and solving "special" problems or deviations from the standard of care. It emphasizes the identifying of outliers or "bad apples", and taking steps to bring their performance in line with the norm.

Quality Improvement: Quality Improvement (QI) is a proactive, systematic, organization-wide approach to improve the overall quality of care. QI identifies common causes and processes, rather than outliers and clinical outcomes. QI emphasizes performance improvement as well as a standard of care. QI's end result is to prevent errors and to improve rather than to inspect and repair problems and meet standards.

Value or Value-Based Purchasing: A policy adopted by healthcare payers (e.g., the Center for Medicare and Medicaid Services [CMS] and private insurers) and Congress combining benefits in quality with lower costs. For example, studies have shown wide regional variation in care utilization throughout the United States, yet higher utilization does not necessarily lead to higher quality. In this case, higher utilization would be considered to have low value. 

Pay-for-Reporting or Pay-for-Performance: A policy promulgated by payers to create financial incentives for hospitals and providers to report certain specified measures or to perform above a certain threshold on these measures.

Quality Meaures: Healthcare quality measures are generally categorized as "process measures" (focused on intermediate steps taken to improve care, e.g., ordering certain tests or performing related examinations), and "outcome measures" (focused on improving actual disease clinical parameters such as blood pressure or hemoglobin A1c).

Peer Review:consistent, impartial, professional process to hold attending physicians accountable for incidents involving their patients, and a means of.measurement, assessment, and improved organizational performance.

Patient-Centered Medical Home: An initiative to transform primary care to a more longitudinal focus rather than episode-based, and to improve access, population disease control, patient-self management, and the role of primary care physicians as coordinators and managers of care. The patient-centered medical home focus is supported by professional groups including the American College of Physicians and by large employers.

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