Regulatory Agencies and Quality

Regulatory Agencies and Quality

When individuals seek healthcare services, they believe that the healthcare professionals have the knowledge and expertise to deliver quality healthcare services. It is thus critical for healthcare professionals to deliver quality healthcare services. However, this is not always the case all the time. Sometimes, the quality of care delivered by healthcare professionals does not meet the expectations of their patients and other players in the healthcare industry. The healthcare quality in the United States is marred with variations in quality and high costs (Young & Kroth, 2017). Due to this fact, the role of regulatory agencies in the United States and globally has become more critical in the healthcare delivery industry. Healthcare leaders must be aware of the history of the regulatory industry and the changes that have occurred in the regulatory agencies. Some regulatory agencies that healthcare leaders should be aware of include the Joint Commission and the Agency for Healthcare Research and Quality (AQRH).

Historical Development of Health Regulation and Regulatory Agencies

Quality improvement initiatives have been in the healthcare delivery industry for the last 200 years. 1846, Dr.Ignaz Semmelweis advocated hand sanitation to prevent healthcare-associated infections and other conditions. In 1918, the American College of Surgeons developed a hospital standardization program to maintain quality standards during surgical operations. 1966, Dr. Avedis Donabedian established a framework for current healthcare quality models. This model is known as the Donabedian model. Dr. Donabedian laid out three essential factors for assessing and maintaining healthcare quality in this model. These components included structure, process, and outcomes. These measures help determine if a healthcare organization has the resources to deliver quality healthcare by evaluating the healthcare providers’ care capacity, patient outcomes, and treatment processes (Tossaint-Schoenmakers et al., 2021).

Quality indicators are specific metrics used by regulatory agencies and CMS to measure healthcare facilities’ care quality and clinical performances (Rios-Zertuche et al., 2018). Monitoring these metrics helps ensure patient outcomes and identify performance areas that must be improved. Quality indicators include mortality rates, surgical complications, 30-day readmission rates, and hospital-acquired infection scores (Rios-Zertuche et al., 2018). This monitoring aims to determine areas of weakness and to make improvements with performance improvements.

In 1972, President Nixon amended the Social Security Act, which led to the establishment of the Profession Standards Review Organizations (PSRO). These PSROs were physician-operated organizations with federal funding to ensure that Medicaid and Medicare beneficiaries received quality medical care. In the late 1980s and early 2000s, the United States Government established several agencies to enhance healthcare quality. One such agency was the AHRQ. The primary goal of this agency was to improve care quality and clinical safety (Agency for Healthcare Research and Quality, 2021). Other formed organizations include the National Committee of Quality Assurance and CMS Value-based programs, which aim to enhance care coordination, improve accessibility, reduce care costs, and enhance healthcare quality.

Agency for Healthcare Research and Quality

The primary purpose of AQRH is to conduct and support healthcare research regarding healthcare outcomes, appropriateness, and effectiveness of healthcare procedures and services. The mission of this organization is to generate research evidence to ensure that healthcare services are safer, quality, and equitable (Kronick, 2016). It collaborates with many partners to ensure the research evidence is well comprehended and utilized.

The AQRH achieves its mission by investing in research on the United States healthcare delivery industry to understand how to improve the safety and quality of healthcare services (AHRQ, 2018). In addition, it creates materials that train and teach healthcare professionals and systems to integrate the research evidence into healthcare practice (AHRQ, 2018). Finally, it produces data and measures that policymakers and healthcare providers can use to improve the safety and quality of healthcare services (AHRQ, 2018).

Joint Commission

The Joint Commission aims to enhance healthcare quality constantly. It collaborates with other stakeholders to evaluate healthcare organizations and inspire them to provide practical, safe, and quality healthcare (Joint Commission, 2021). This organization certifies and accredits healthcare programs in the United States. It solves healthcare critical safety issues and quality programs and offers educational services, software, and publications to complement the accreditation experience (Joint Commission, 2021)

How Regulatory Agencies Have Impacted the Quality of Care

Regulatory agencies have to lead to improvement in the quality of care. The Joint Commission is a strong force in patient safety and quality improvement in healthcare. Through its leading practices, expertise, knowledge, and standards, the Joint Commission helps healthcare organizations enhance patient safety and cause zero harm to the patient. This commission’s standards form the foundation of objective evaluation processes that help healthcare facilities measure, evaluate, and enhance performance (Joint Commission, 2021). These standards focus on patients, resident care, and healthcare organizations that provide quality healthcare services. These standards are developed through collaboration with service providers, healthcare professionals, government agencies, and healthcare standards. These standards have led to the improvement of healthcare quality and safety.

The AHRQ develops tools for healthcare professionals, physicians, and nurses to enhance quality, safety, and patient engagement in nursing homes, physicians, and hospitals. This organization funded a tool called the Re-Engineered Discharge (RED) toolkit to reduce avoidable readmission rates (Mitchell et al., 2017). The NCQA develops evidence-based standards that healthcare professionals should implement to improve the quality of care. This organization publishes measures that healthcare providers should implement. In addition, it conducts studies to determine if the measures implemented by healthcare organizations have effectively met quality goals (NCQA, 2021).

 Deemed status

Deemed status is when an organization has met and exceeded the expectations for a particular expertise area. This status can only be given through accredited agencies such as the Centers for Medicare and Medicaid Services.

Ways in Which Quality Has or Has Not Improved Since the 1800s

Unlike the modern world, quality improvement efforts in the 1800s only involved individual healthcare professionals implementing hand hygiene and sanitation measures in healthcare environments. These efforts did not have many stakeholders and players like it is currently happening. There were no quality standards for healthcare professionals to follow in implementing quality efforts. Healthcare professionals implemented the measures. There was also limited accountability, data collection, or reporting compared to current events. There were no quality regulatory agencies such as CMS or AHRQ to guide the critical areas that need improvement. Thus, healthcare professionals and individuals did not require any accreditation from regulatory agencies. There are many quality regulatory agencies like the Joint Commission and NCQA. Data collection has led to evidence-based strategies to improve healthcare quality. There is also a multisectoral collaboration between healthcare professionals, experts, and organizations. The patients are at the center of the quality improvement programs. Thus, quality has improved since the 1800s.

Conclusion

In conclusion, healthcare quality has improved in the United States since the 1800s. During that period, quality improvement programs were mainly done by professionals at the organizational level. Currently, many regulatory agencies, such as the Joint Commission and AHRQ, are tasked with helping healthcare organizations enhance the quality of care.

References

Agency for Healthcare Research and Quality. (2021). Offices, centers & programs. https://www.ahrq.gov/cpi/index.html

AHRQ. (2018). Agency for Healthcare Research and Quality: A profile. Agency for Healthcare Research and Quality. https://www.ahrq.gov/cpi/about/profile/index.html

Joint Commission. (2021). About us. Leading the Way to Zero | The Joint Commission. https://www.jointcommission.org/about-us/

Kronick, R. (2016). AHRQ’s role in improving quality, safety, and health system performance. Public Health Reports, 131(2), 229-232. https://doi.org/10.1177/003335491613100205

Mitchell, S. E., Weigel, G. M., Laurens, V., Martin, J., & Jack, B. W. (2017). Implementation and adaptation of the re-engineered discharge (RED) in five California hospitals: A qualitative research study. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2242-z

NCQA. (2021, June 17). About NCQA. https://www.ncqa.org/about-ncqa/

Rios-Zertuche, D., Zúñiga-Brenes, P., Palmisano, E., Hernández, B., Schaefer, A., Johanns, C. K., Gonzalez-Marmol, A., Mokdad, A. H., & Iriarte, E. (2018). Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries. International Journal for Quality in Health Care, 31(3), 183-190. https://doi.org/10.1093/intqhc/mzy136

Tossaint-Schoenmakers, R., Versluis, A., Chavannes, N., Talboom-Kamp, E., & Kasteleyn, M. (2021). The challenge of integrating eHealth into health care: Systematic literature review of the Donabedian model of structure, process, and outcome (Preprint). https://doi.org/10.2196/preprints.27180

Young, K. M., & Kroth, P. J. (2017). Sultz & Young’s health care USA (9th ed.). Jones & Bartlett Learning.

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Regulatory Agencies and Quality

For this assignment, you will write a 3-5 page paper in which you analyze why regulatory agencies began monitoring quality and explain how organizations like the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, and other regulations have impacted quality of care, explain what is meant by “deemed status,” and evaluate ways in which quality has or has not imp the 1800s.
You are required to organize your paper using the following headings:

Title Page

• Introduction.
Preview the main themes of your paper.
Historical Development of Health Regulation and Regulatory Agencies.
Analyze why regulatory agencies began monitoring quality in health care.
Briefly describe the purpose and goals of the Agency for Healthcare Research and Quality (AHRO)
Briefly describe the purpose and goals of The Joint Commission
How Regulatory Agencies Have Impacted Quality of Care.

Explain how organizations like the AHRO, The Joint Commission, and other regulatory agencies have impacted the quality of care.

Explain what is meant by deemed status.”

•Ways Quality Has Improved or Not Improved since the 1800s

Understanding the History of Quality of Care!!

• Conclusion.
Summarize the main themes of your paper.

• References.

A template is provided in the assignment resources.
Paper Requirements
Your paper will be a minimum of 3-5 double-spaced pages in length, not including title and reference pages.
Font: Anal 12 point,
Cite at least four references, thr

Format your paper according to APA style
in addition to your textbook.

Note: To fully understand how this assignment will be graded, read the Regulatory Agencies and Quality Scoring Guide carefully. Scoring Guide Criteria
1. Analyze the development of health regulations and regulatory agencies.
2. Analyze how regulatory agencies have impacted the quality of care
3. Evaluate how quality has improved or not improved since the 1800s.
4. Discuss initiatives taken by healthcare organizations to reduce and/or mitigate risks.
5. Produce writing that conveys an understanding of the topic, its context, and its relevance.
6. Produces writing with minimal grammar, usage, spelling, mechanical errors, and proper APA formatting and citation style.

Resources
Regulatory Agencies and Quality Scoring Guide.