Quality Management in Hospitals

Quality Care Management Control

All the regulations for quality management in hospitals prescribe policies, procedures and responsibilities for the administration of the Hospital Quality Management Programs including policies addressing medical services quality management requirements, quality health care and medical records documentation controls. These quality control systems allow a care team to know the status of each of their patients regarding required preventive, screening, and chronic disease management services based on practice-specified care guidelines. These quality management controls act as a tool to reach patients at the point-of-care and ensure that staff manages the entire patient population effectively and efficiently.

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Promoting Quality Patient Healthcare and Management Services

Promoting quality patient management is mandatory under clinical quality management systems, and requires that contracted practitioners adhere to reasonable practice parameters. Diagnosis, evaluation and treatment are significant parameters of clinical decision-making for any quality management in hospitals. The practitioner must demonstrate a clinically suitable approach to his/her clinical decision-making processes. This approach is dependent upon the clinical awareness and the experience of the practitioner in his/her respective field, skill in clinical appraisals, deductive reasoning, as well as a pattern of recognizing patient safety, i.e., the avoidance and recognition of practices that could make a patient’s situation worse.

The approach should also include the management of adverse outcomes to assist the practitioner in understanding the level of evaluation and documentation that is suitable; and, how this documentation reveals clinical practices consistent with legal practice parameters, and management of expected clinical outcomes. The hospital data that is in the submitted documents serves as the basis for the hospital service manager’s assessment of the practitioner’s hospital decision-making (in terms of hospital quality services management and treatment utilization).

To satisfy the requirements for quality management in hospitals, practitioners must include adequate patient demographic information enabling accurate patient identification. In the event that the documentation is inaccurate or incomplete, the hospital services management or administration can contact the practitioner for required clarification as the practitioner is allowed the opportunity to provide the necessary information upon notification, and failure to do so could result in an administrative action or the disapproval of reimbursement for submitted treatments/services.

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Successful Administrative Reviews for Quality Management in Hospitals

Upon successful administrative review, documentation is sent to a licensed, peer clinical services manager for verification. Treating practitioners are expected to have constant communication with a referring healthcare provider, wherever applicable, and co-management of the patient’s care among practitioners is expected. Some factors like surgical procedures, patient’s age, medical history, responses to earlier treatment, occupational factors, etc., may affect the expected response under consideration.

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Quality Controls for Patient Care Reviews

All cases, with respect to quality management in hospitals, receive evaluation considering all relevant hospital data for a patient’s unique hospital situation and clinical outcome. Similar case studies may be handled with a similar approach with the expectation of reasonably consistent results. For a given diagnosis, the effect of variability in general health status such as age, gender, past medical history, psychosocial factors, and presence of co-morbid conditions, etc., makes the use of diagnosis-specific treatment durations a specific benchmark for procedural healthcare controls and quality management in hospitals.

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