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Objectives

  • This module will enable you to:
    • cite the major groups and agencies who monitor the health care system and their methods.
    • identify programs, standards, and instruments used to measure clinical performance and patient satisfaction.
    • describe initiatives in public reporting and reimbursement that impact the marketplace presence and quality improvement efforts of physician practices and other providers.

    Competency

    The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) maintain a common set of six core competencies. This module addresses the competency of Systems-based Practice and these specific objectives:
    • Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
    • Advocate for quality patient care and optional patient care systems

Module Elements

Contents

The module has three content sections:

A. Organizations Engaged in Quality Oversight
Health care organizations, including health plans, hospitals, and physician practices are subject to accreditation and assessment by outside organizations. This section looks at major review organizations and their approaches tto quality oversight.

B. Performance Measurement
Several public and private organizations are leading the way in setting goals and developing measurement standards for health plans and providers. This section describes important public and private initiatives and the types of measures currently in use.

C. Report Cards and Pay-for-Performance
Performance profiles, or "report cards," present performance data to enable purchasers and consumers to make better selections of health plans and providers. Also, insurers incorporate quality measurement in pay-for-performance programs to set goals and reward performance. This section considers these developments and cites examples.

Each section has an introduction and summary. The concluding section then presents a statement on future trends and summary comments.

After viewing all the contents, learners are instructed to reflect on the contents by answering three questions:

  1. What new knowledge and insights did you gain from taking this module that will (a) help you care for patients, and (b) maintain a fulfilling practice?

  2. Thinks about the knowledge and perspective provided by this module, what additional knowledge and skills do you think it would be helpful to acquire in your training?

  3. What is your plan for acquiring this new knowledge and skills?

Learners then complete a five-question post-test.

Tufts Health Care Institute Online Learning
This module is one of several online learning modules created by Tufts Health Care Institute, an educational institute founded by Tufts University school of Medicine and Tufts Health Plan. The modules address topics related to the cross-disciplinary competencies mandated by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS), specifically Systems-based Practice, Practice-based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills.

Graduate medical education programs may subscribe to the Tufts Health Care Institute (THCI) Online Learning Campus to integrate the modules and applied learning exercises into their training. For information, go to the THCI website or contact THCI at support@thci.org.

Author
The module was developed by Tufts Health Care Institute-Ralph Halpern, editor-with lead author David Nash, MD. Dr. Nash is the Founding Dean and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson School of Population Health (JSPH) of Thomas Jefferson University in Philadelphia, Pennsylvania. JSPH provides innovative educational programming designed to develop healthcare leaders for the future. Dr. Nash is a board certified internist who is internationally recognized for his work in outcomes management, medical staff development and quality-of-care improvement.