ABSTRACT
The Veterans Affairs External Peer Review Program (EPRP) reviews patient care episodes in Veterans Affairs Medical Centers (VAMCs) across the United States. This review process uses screening algorithms, followed by peer review, to identify deviations in the care provided by the VAMCs. A schematic model of the case selection, data acquisition at each VAMC, data flow between the VAMCs and the West Virginia Medical Institute (WVMI), data processing at WVMI, and the peer review process are given. A model pneumonia clinical practice guideline was generated by an expert panel of physicians external to the VAMCs. This guideline identifies benchmark criteria that reflect the clinical standards for diagnosing and treating hospitalized pneumonia patients. A screening algorithm was then designed, tested, and implemented to identify deviations in the quality of care delivered by VAMCs to hospitalized pneumonia patients.
Subject(s)
Algorithms , Hospitals, Veterans/standards , Mass Screening/standards , Peer Review, Health Care/methods , Pneumonia/prevention & control , Adolescent , Adult , Aged , Humans , Middle Aged , Pneumonia/diagnosis , Practice Guidelines as Topic , Random Allocation , United StatesABSTRACT
The Health Care Financing Administration (HCFA) has launched and ambitious new program for Peer Review Organizations (PROs) called the Health Care Quality Improvement Program (HCQIP). The goal of HCQIP is to improve the quality of care for all Medicare beneficiaries through cooperative interaction between PROs, providers, and physicians. The West Virginia Medical Institute, which serves as the PRO for West Virginia and Delaware, has recently begun to implement the changes required by HCQIP. This article explains the various approaches WVMI will use to achieve the health care improvement goals set forth by HCFA.
