Healthcare Quality Assurance Article Reviews

Healthcare quality assurance article review

What are the tools used by the AHRQ in managed care


The aim of every medical institution is the provision of excellent health care. To do this, there are certain standards relating to quality that have been established. Managed Care Organizations receive their funding via the Medicaid and Medicare programs. The federal and state governments have set certain standards pertaining to quality. These are the standards that the Managed Care Organizations are supposed to adhere to.

The importance of access to complete clinical information that is evidence based cannot be gainsaid as far as meeting their responsibilities is concerned. In addition the organization would require to have information pertaining to measures on clinical performance. All this information is useful in evaluating the performance of the provider under the organization as well as look into areas that may need some bit of improvement. In addition, they would be collecting information pertaining to the feelings of the members pertaining to the treatment they are receiving.

You will therefore acknowledge the need to have measurement tools that are reliable, valid and which would not cost much. Unfortunately, there has been a deficiency of these tools in the past. Moreover, the performance measurement science has been a new phenomenon and therefore there is need to for the development of additional measures as well as the improvement of the existing ones. What are the tools that can be used to improve the services offered by the organizations? This article is aimed at looking at these tools


In light of the numerous challenges that Managed care organizations face presently, the researchers have come up with tools, put them into testing and looked into their effectiveness through implementation. The various tools include

The National Guideline Clearinghouse (NGC)

The main goal of the National Guidelines Clearinghouse is to offer providers of health care, health plans, purchaser as well as other institutions access to information that is detailed as well objective pertaining to guidelines of clinical practice. It also enhances the ability of these institutions to disseminate, execute as well as use this information. The importance of this lies in enabling the institutions to determine whether their patients are getting appropriate care in the appropriate time.

The National Guideline Clearinghouse makes for a complete database of guidelines on clinical practice Backed BY Evidence as well as documents that are related. The Major Components of the National Guidelines Clearinghouse include the summaries touching on the guidelines as well as their development, the ability for comparison of guideline and combinations of guidelines covering topics that are similar while looking into their differences and similarities. Also contained in this tool are bibliographies on the use, implementation as well as the development of guidelines.

National Quality Measures Clearinghouse

The basic for establishment of this particular tool was the promotion of enhanced access by Managed Care Organizations to measures that are of high standards. This is after the recognition of the fact that there is need for these organizations to access reliable as well as efficient methods for quantifying the quality of health care. It makes for an information database on particular quality measures of health care. One thing that you would appreciate bout this tool is the ability of the user to simultaneously search it and the NGC.

Patient Outcome Research Teams

This tool was established in order to establish whether MCO providers offer quality care. It incorporated a research done by teams drawn from various disciplines. This project formed the basis by which the productions of measures as well as outcomes were refined as well as defined.

Other tools included Q-span, Consumer Assessment of Health Plans, Child Health Toolbox and the United States Preventive services Task Force. All these tools were aimed at looking into ways of improving the delivery of quality services by the Managed Care Organizations.

What is the impact of these tools?

With the increase in the enrolment of individuals to Managed Care organizations, there were fears about the probability of diminishing quality OF health care provided. In addition, there were concerns about the impact of changes in the technologies, cost pressures as well as variations pertaining to the healthcare provision. Nevertheless, the organizations were in apposition to demonstrate the maintenance as well as improvement in the provision of healthcare to the members. This was done using the valid, reliable as well as systematic methods of quality care provision, comprehensive measurement of their success as well as being in a position to give a feedback as to the finding.

Due to the availability of these valid and dependable tools, the concerned stakeholders have been in a position to use them to enhance the quality of the services they avail to their patients.


AHRQ Tools for Managed Care. Research in Action Issue 11. AHRQ Publication No. 03-0016, March 2003. Agency for Healthcare Research and Quality, Rockville, MD.



Medical systems have undergone a lot of changes in the recent times especially with the entry of private institutions in the market. You will acknowledge that there has been a rise in the cost of health care services. This has led to the dominance of the managed care in the delivery system of health care. It would be important to note that there has been an increase in the number of individuals signing up in the managed care systems as well as Health Maintenance organizations.

Managed care incorporates systems that depend on each other and deal with the delivery and the financing of health services. However, you will acknowledge that there are differences as pertaining to their ways of health care delivery, ease of health care access as well as the range of services that are provided. Nevertheless, there are gaps as pertaining to the knowledge of the far reaching effects of this service on the quality, cost as well as access to care.

What is the role played by the AHCPR in the strengthening of managed care?

The Agency for Health Care policy and research has played a pivotal role in enhancing the strength of the managed care. It has been very supportive of the studies pertaining to the changes in the managed care. In addition, it has been reaching out to the private sector in an effort to build consensus on the way forward in increasing the quality As Well as accountability in the health care provision.

This agency has also been providing information pertaining to the viability of the management systems as well as alternative practices. In addition, they have been looking into the problems encountered as well as the successes that have been attained. All this is aimed at enhancing the quality of health care provision.

Basis of the efforts.

A research supported by the agency has shown that patients served by the managed care systems spent less time in the ICU than those who had insurance plans that would pay for the services. In addition, it was noted that HMO patients underwent less hospitalization as compared to those who paid some fees for the health service. Also, doctors in services that charged would spend less time with the patients as compared to HMO doctors. Basically, it was noted that patients who were chronically ill had enhanced access to health care in the managed care programs as compared to those in the services where they would pay some fees.

Basically, this research showed that there was better likelihood of recovery in the managed care institutions than in the services where individuals were required to part with some fees.

Continuing research

There are various studies that are being conducted with an effort to show the effect of certain activities on the improvement of health care provision. This is done in an effort to come up with the most effective strategy. There have been studies on impact of transferring beneficiaries of Medicaid to the managed care. In addition, the impact of constant improvement of quality on the preventive services delivery in clinics that deal with primary care is under study. In addition, there are studies on the methods that doctors in primary care facilities use to manage pain. These are aimed at determining whether there is any correlation with the various risks pertaining to chronic pain in patients having headaches and back pain.

Research on rural populations.

It has been noted that the rural populations are less healthy than their non-rural counterparts. In this case, there have been concerted efforts to enhance the development and establishment of health institutions in the rural areas. This is actually the basis for managed care institutions in the regions or state. In addition, there have been demonstrations on the ways in which the rural health care systems can be improved by incorporating creativity in the financing, delivery as well as the organization of health services.

Other studies.

Presently, research is being carried to determine the number of people with benefits pertaining to managed care. There are also studies aimed at looking at the effects of market structures changes on the production of providers of health care as well as the price, service quality, market care and distribution.


The agency has been a leading light in the support of research aimed at improving healthcare quality. This has been through the numerous research programs, the improvement of the clinical guideline as well as the technological assessment. These have been very much effective in availing practical, valid information that is based on science to all the stakeholders involved. These include the medical practitioners, consumers as well as other purchasers of healthcare.


Strengthening Managed Care. Research in Action Fact Sheet. AHCPR Publication No. 96-P045, June 1996. Agency for Health Care Policy and Research, Rockville, MD.