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US groups set standards of outpatient care
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     Americans make more than a billion visits to doctors?surgeries and hospital outpatient and emergency departments

    for medical care every year, but until now there have been few standards for gauging the quality of care that

    doctors provide in the outpatient setting.

    This month a set of voluntary national standards was agreed on by more than 260 healthcare providers such as

    healthcare plans, consumers?groups, professionals?organisations, purchasers of health care (such as employers),

    federal agencies, and research and quality improvement organisations.

    The groups were brought together by the National Quality Forum, a private, non-profit organisation that aims to

    standardise the measurement and reporting of the quality of health care. The standards are based on measures

    submitted by the American Medical Association, the Centers for Medicare and Medicaid Services, and the National

    Committee for Quality Assurance.

    The 36 standards cover asthma and respiratory illness; behavioural health and depression; osteoarthritis; heart

    disease (coronary artery disease and heart failure); hypertension; prenatal care; and prevention, immunisation, and

    screening.

    This is a "starter set" of voluntary standards that will take effect this autumn after a consultation period, said

    Philip Dunn, vice president for communications and public affairs of the forum.

    Mr Dunn said that the standards could be used for federal and state reporting and by hospitals, health plans, and

    large medical practices. He said the standards might also be used in "pay for performance" programmes to reward

    healthcare providers that provide good quality care. The Centers for Medicare and Medicaid Services have a

    demonstration project under way in a few very large medical practices, he said.

    "The next step is for health plans to adopt the standards. It抯 difficult to make doctors adopt standards, but if a

    health plan requires collection of data , that might increase adoption of the standards," he said.

    Another non-profit group, the National Committee for Quality Assurance, which accredits health plans, announced

    that 57 health plans covering more than 13 million people have signed up as "early adopters" of the organisation抯

    new care management and health improvement standards. The standards—developed with information from healthcare

    providers, employees, and consumers—focus on prevention, disease management, and the management of complex cases.

    They are "a voluntary add-on" to the organisation抯 accreditation programme for health plans, said Barry Scholl,

    vice president for communications and marketing. He said the standards focused on people with several problems that

    were more complex than those covered in the usual disease management programmes (for example, an obese patient with

    diabetes and heart disease). He expected the standards to become part of the accreditation programme for several

    types of health plans.

    Mr Scholl said that consumers often "feel lost" in dealing with health plans and that the new standards would help

    plan the care of members with complex conditions. For example, a health provider might send the patient reminders

    about check ups, leading to better care. The standards would also provide reminders to doctors, such as reminding

    them shortly before they saw a patient with diabetes that the patient should have an eye examination.

    "Employers tell us they want health plans to offer more," he said. He added that the standards looked at how well

    health plans use sources of information to identify and manage members with chronic illnesses or complex

    conditions. They asked plans not only whether "case management" programmes existed for complex conditions but how

    effectively members who might benefit were referred to the programmes.(Janice Hopkins Tanne)