JCAHO's proposed rules on clinical practice guidelines.
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Biomedical subjects
Publications and source records attributed to J Homa-Lowry.
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The role of case managers in reviewing and analyzing outcomes data as part of the Joint Commission on Accreditation of Healthcare Organizations' ORYX initiative is often neglected. Case managers who become involved in reviewing ORYX data should first find out who the data vendor is and what methods are used for severity adjustment or risk adjustment. Information from ORYX can be used to evaluate areas of potential improvement in the case management program and identify ways to refine and add to existing clinical pathways.
Since 1965, when the Medicare and Medicaid programs were established by amendments to the Social Security Act, there has been an evolution from internal utilization review of hospital care to internal and external review of quality assurance. Hospitalizations for diabetes as a primary diagnosis have decreased over this period, suggesting that more diabetes care is delivered as outpatient care and is therefore not subject to quality assurance review. Although it is difficult to discern the effect of quality assurance programs and case management on the quality of diabetes care, it is certain that these programs will have a major influence in the future.
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As the cost of health care increases, but the resources available to deliver patient care decrease, the issue of quality becomes a major concern for everyone either receiving or delivering health care services. Adding to the complexity of the quality issues facing health care institutions have been a number of recent health care articles reporting patient safety issues. These issues have ranged from medical mistakes to medication errors. Factors cited as contributing to these errors have been the shortage of resources, shortage of professionals to provide direct patient care, i.e. nurses, and the increasing cost of providing health care services.