American Journal of Medical Quality

This article reports on the progress of a fellowship program for physicians in quality assurance and uti lization review (QA/UR). The article begins with a description of the initial program concept and pre sents the "program-in-action" including: academic coursework, site rotations, learning experiences of the fellow/resident, funding, outcomes to date, strengths and weaknesses analysis, current require ments, and future research and development needs. By presenting design and operations this 2-year progress report is intended to assist other developing programs as QA/UR education increases nationally.

This article explores the need for health care qual ity assurance professionals to keep up with scientific information related to both quality management and clinical medicine. Using data from a recent survey of this nation's primary practitioners and their national opinion leaders, the three basic functions of science information management are reviewed and related to QA tasks. The article suggests that education and training for QA professionals in "science information management" might substantially enhance their im pact in terms of improved outcomes of health care. Finally, several basic educational goals are listed for those who wish to develop proficiency in this devel oping field of information management.

Quality assurance may be viewed as a method for the surveillance of healthcare provided in hospitals and other settings. The processes involved in quality assurance are in many ways analogous to the concepts and techniques that comprise the discipline of epide miology. As yet, there has been little interaction be tween these specialty areas, and the lack of recogni tion of their relevance to one another is exemplified by the fact that hospital epidemiologists are rarely called upon to assist in the planning and operation of quality assurance programs. This loss of opportunity may be remedied by the inclusion of quality assurance methodology in the training of epidemiologists, and the introduction of certain epidemiologic concepts and methods into the quality assurance curricula. The intersection of these two disciplines will enlarge the scope of both and foster advances in theory and prac tice in this field.

Three court decisions reviewing medical peer re view conducted in hospitals were discussed at length in part III of this article. In their opinions the courts gave at least tacit approval to the procedures followed in the hospitals, and they accepted that an evidentiary basis for adverse action against the physicians was present. But not all medical peer review in hospitals resulting in adverse actions is found satisfactory when challenged in court, and the most prominent litigation in the decade of the 1980s concerning med ical peer review, Patrick v. Burget (1), is testimony to the potential for its perversion.

Part II adverted to the potential for bias or lack of objectivity in assessing physician performance. Part I mentioned the problem of bias in the context of peer review of articles for publication and of research grant proposals.

The objectives of Part IV are: (1) to examine the concern about bias in medical peer review and to indicate how it may be lessened, if not eliminated; (2) to address further the difficulty created by the rela tive lack of valid criteria to employ in medical peer review; (3) to review the extent of protection from liability afforded to participants in medical peer re view ; and (4) to describe the changes that should be anticipated in review of medical services in the fu ture.

Before addressing these subjects it is essential to remind the reader that medical peer review is not conducted primarily for disciplinary purposes; rather, its purpose is to evaluate the quality of care. If the care is below the desired level, then steps to modify practitioner professional conduct by provid ing information about the effectiveness of diagnostic and therapeutic interventions, and imposing limits on practice if necessary, are warranted. Thus, while adverse credentialing decisions may follow medical peer review, they should not be viewed as its objec tive.

This paper reports on the design, presentation, and evaluation of a graduate university course in quality assurance and utilization review. The authors cite the need for expanded course offerings in this field and present descriptions of the course design and student participants, including program location, objectives, learning themes and content, instructor team, stu dents, and course process. Student feedback is re ported including comments on course strengths and needs, teaching methods, and learning evaluation. Additional work requirements are cited.

This article presents the first data on the charac teristics of applicants to the physician fellowship pro gram in quality assurance (QA) and utilization review (UR). Data presented about applicants include demo graphic characteristics, board and national certifi cations, specialties, license type, practice experience, and QA and UR experience. These data were obtained from individual applications for admission to the pro gram. They are used here to create a database for the program to generate future information on this new specialty group. Characteristics of current applica tions selected begin to define the members of the profession.

This article discusses the need for a national plan for quality assurance and utilization review (QA/UR) education. Six points are addressed: the rationale for planning; the developments in quality assurance urg ing plan creation; external pressures on the QA field; internal interests in educational program develop ment ; a beginning vision of an educational future; and strategies for realizing the future. Additional planning and policy tasks are defined.