(2) the accreditation of health care facilities.
(3) the necessity of considering the severity or stage of the disease.
(4) comorbidity (two or more illnesses present at one time).
(5) the behavior of the patient in health and in illness.
(6) the economic barriers to receiving medical care.
ORGANIZATIONS/LEGISLATION REGULATING QUALITY ASSURANCE
a. Hospital Standardization Program. In 1913, the American College of
Surgeons (ACS) was formed as an accrediting body, generating standards for medical
education and performance. An explicit goal of this organization was the improvement of
patient care in hospitals. In 1917, ACS published "Minimum Standards for Hospitals." In
1918, the Hospital Standardization Program was initiated, in which the concept of hospital
accreditation was advocated as a formal means of assuring good hospital care. Hospitals
were offered voluntary surveys. Only 90 of the 692 hospitals initially surveyed were
approved. In 1922, a patient admitted to a hospital had a 50-50 chance of recovering.
b. Joint Commission on Accreditation of Hospitals (JCAH). In 1952, the Joint
Commission on Accreditation of Hospitals was established to assume responsibility for
the accreditation program. The purpose of JCAH was to encourage voluntary attainment of
uniform high standards of institutional care in all provider areas (nursing, radiology,
pharmacy, etc). Some states require accreditation for licensure, and some third party
payers require accreditation as a condition for reimbursement for Medicare. In the 1970s,
JCAH expanded its accreditation program to include not only hospitals but also facilities
for ambulatory care, long-term care, psychiatric and mental health care, and the care of
mentally retarded and other developmentally disabled persons. JCAH later became the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
c. Medicare/Medicaid . When Congress passed Public Law 89-67 in 1965,
providing Medicare/Medicaid for the elderly, permanently disabled, and the indigent, the
requirement that the level of patient care had to meet certain standards was included in the
legislation. To participate in Medicare/Medicaid programs, a hospital must comply with
these requirements and be continuously under review and evaluation.
d. Professional Standards Review Organizations . After the enactment of
Medicare in 1965, the federal government established utilization review of hospital and
physician reimbursements. The increase in government participation and funding was
followed by an increase in demands for accountability of the cost and quality of the services
provided. However, the utilization review program proved ineffective. To correct this
situation, Public Law 92-603, Amendments to Social Security Act, was passed in 1972