Quality assurance issues.

Abstract

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.