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  • Title: Quality assessment of reproductive health services.
    Author: McGlynn EA.
    Journal: West J Med; 1995 Sep; 163(3 Suppl):19-27. PubMed ID: 7571599.
    Abstract:
    Systematic information on the quality of health services is being sought by purchasers and providers of health care. Consensus on an appropriate set of quality assessment criteria should stimulate the development of data collection tools and analytic methods. To begin the dialogue, criteria for evaluating the quality of family planning services, routine gynecologic care, infertility care, male reproductive health services, prenatal care, and early postnatal care are necessary. The effect of report cards on measurement and reporting and the challenges of assessing quality in family planning and other clinic settings are discussed. Reproductive health services include family planning, routine gynecologic care, treatment for infertility, male reproductive health services, prenatal and early postnatal care. This article examines quality assessment at the health plan or clinic level . The structure of the care delivery system includes a variety of community, individual, health provider, and health system characteristics. The outcomes of care include a multidimensional set from the delivery of services: clinical status, functional status, and satisfaction with care. Three sources of data are generally used to conduct quality assessments: administrative data, medical records, and surveys. Regarding quality measures of existing reproductive health, four efforts representative of different approaches are considered: 1) the Health Plan Employer Data and Information Set (HEDIS) developed by the National Committee for Quality Assurance (NCQA) for use in comparing performance among managed care plans; 2) Kaiser Permanente-Northern California Region quality report; 3) The RAND/HMO Quality of Care Consortium measure of quality of prenatal care in six managed care plans; and 4) The RAND/HMO Quality of Care Consortium hysterectomy use appropriateness measure. HEDIS provides detailed specifications for constructing measures of health plan performance in four areas. The Kaiser Permanente report card was intended for use by consumers and health care providers. Given Kaiser's participation in the development of HEDIS, some overlap exists between the HEDIS measures and those provided in the Kaiser report card. RAND/HMO Consortium identified 14 clinical areas for the development of quality assessment measures for use in making comparisons among managed care plans; prenatal care was one of the target areas for which a detailed clinical measure was developed and tested in six managed care plans. The RAND/HMO Consortium-Appropriateness of Hysterectomy measure revealed that overall, 16% of hysterectomies were considered inappropriate, and the range among the individual health plans was 10% to 27%.
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