Quality management is vital in many health maintenance organizations in the United States and the world. Several state regulations and laws require health maintenance organizations to deploy quality management programs. The quality management programs are population-based (Kongstvedt, 2019). This implies that they focus on quality elements applicable to many members in a single plan. Many quality management programs consider specific conditions of Medicare, such as treating and preventing chronic diseases such as diabetes. Avedis Donabedian developed a classic and enduring quality management model that categorizes quality management activities into three major groups; structure, process, and outcome.
According to the Institute of Medicine, there are six essential quality care features: safety, effectiveness, patient-centered, timely, efficient, and equitable. Many healthcare facilities in the world aim to provide patient centered care. Quality management plays a crucial role in attaining this objective. In the Avedis classic quality management, structure encompasses the context within which services and care are offered in healthcare facilities rather than how the care of offered or the result or the outcome of the care (Kongstvedt, 2019). Structural measures in quality management include credentialing criteria, accessibility, and the healthcare professional's office's physical location. It also encompasses other aspects such as the language and other cultural issues associated with a physician. The process tends to focus on the specific way in which medical services are provided.
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The process focuses on what the medical professionals are doing and how they undertake the care activities. In some instances, process studies involve chart reviews; these reviews focus on selected health conditions such as heart disease and diabetes. The outcome emphasizes the outcome or the results of care (Kongstvedt, 2019). For instance, a patient's positive outcomes with heart attack-related complications would be to recover fully with minimal or no complications at all. Outcomes in quality management include injury or illnesses, deaths, improvement in blood pressure, and reduced emergency department visits.
References
Kongstvedt, P. R. (2019). Health insurance and managed care: what they are and how they work . Jones & Bartlett Publishers.
