Quality Management

Although cost containment has been the dominant catalyst behind the move to managed care systems, there is now strong and growing interest in evaluating and improving the quality of care. Quality of care has been defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM, 1990a).

Quality Management :
A model quality management plan has been developed. Its elements include:
a provider profiling system to evaluate provider performance and to inform the local authority as to whether the provider is meeting the terms of its contract;
indicators for assessing consumer satisfaction and provider satisfaction;
methods for identifying areas of improvement;
the membership of the quality improvement committee; and
the credentialing process performed by the local authority to ensure competent and quality providers.

Within the mental retardation local authority waiver, the Quality Assurance and Improvement System (QAIS), a self-assessment system that measures individual outcomes as they relate to the person receiving services and their perception of those services, their wants, needs and desires, will be required of the private provider network. Validation functions will be performed by the local authority

2600.26. Quality management.

   (a)  The home shall establish and implement a quality management plan.

   (b)  The quality management plan shall address the periodic review and evaluation of the following:

   (1)  The reportable incident and condition reporting procedures.

   (2)  Complaint procedures.

   (3)  Staff person training.

   (4)  Licensing violations and plans of correction, if applicable.

   (5)  Resident or family councils, or both, if applicable.

   (c)  The quality management plan shall include the development and implementation of measures to address the areas needing improvement that are identified during the periodic review and evaluation.