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Quality - Quality is, according to the Institute of Medicine (IOM), the amount to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality can be defined as a gauge of the degree to which delivered health services meet recognized professional standards and judgments of value to consumers. Quality may also be seen as the degree to which actions taken or not taken exploit the probability of beneficial health outcomes and minimize risk and other untoward outcomes, given the existing state of medical science and art.
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Quality Assurance (QA) - Activities and programs planned to assure the quality of care in a defined medical setting. Such programs include peer or use review components to identify and remedy deficiencies in quality. The program must have a mechanism to assess its effectiveness and may measure care against pre-established standards.
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Quality Assurance Reform Initiative (QARI) - A process residential by the Health Care Financing Administration to extend a health care quality improvement system for Medicaid managed care plans. The Quality Assurance Reform Initiative was unveiled in 1993 to aid States in the development of continuous quality improvement systems, external quality assurance programs, inner quality assurance programs, and focused clinical studies.
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Quality Assurance Reporting Requirements (QARR) - The set of performance measures used by New York State to charge the quality of care provided by HMOs and managed care plans serving New York residents.
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Qualified Beneficiary - Normally, qualified beneficiaries include covered employees or enrollees, their spouses and their reliant children who are covered under a group health plan. In certain cases, retired employees, their spouses and dependent children might be qualified beneficiaries.
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Quality Improvement (QI) - The Quality Improvement is also called performance improvement (PI). QI is a management technique to assess and recover internal operations. QI focuses on organizational systems rather than individual performance and seeks to incessantly improve quality rather than reacting when certain baseline statistical thresholds are crossed.
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Quality Improvement Organization - Groups of practicing doctors and other health care experts that are salaried by the federal government to check and improve the care given to Medicare patients. These doctors also appraisal fast-track termination decisions in comprehensive outpatient rehabilitation facilities, skilled nursing facilities, and home health and hospice settings for people in Medicare Health Plans.
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Quality Improvement System for Managed Care (QISMC) - A CMS program designed to strengthen MCO's efforts to protect and improve the health and approval of Medicare and Medicaid enrollees.
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Quality Management (QM) - To use interchangeably with Quality Assurance (QA), Quality Management usually involves an internal review process that audits the quality of care to deliver. And implements corrective actions to cure any deficiencies identified in the quality of direct patient care, administrative services or support services.
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Quality Management Committee - The MCO committee that oversees the organization's quality assessment and improvement activities in both clinical and no clinical areas.
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