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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Information Technology and Quality
Improvement

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What are the roles of key stakeholders in QI?

There are several different stakeholders in the QI process including: patients, providers, payers, public health professionals, organizations that support quality improvement activities, and policy makers.  Each of these stakeholders has a unique role in ensuring successful quality improvement.  Patients have an interest in experiencing quality improvement in the care they receive.  From the patient’s perspective, the four domains for quality improvement defined by the Foundation for Accountability (FACCT) are intended to address health care needs across a patient’s lifespan, namely to stay healthy, to get better, to live with illness or disability, and to cope with end of life.   The role of the provider is to deliver care with respect to the patient’s perspective of quality improvement, as well as care that is safe, effective, patient-centered, timely, efficient and equitable as defined by the Institute of Medicine (IOM).  Further, quality reporting establishes accountability between providers and patients.  Providers become aware of gaps in care and reporting on QI such as proactive outreach and chronic disease monitoring encourages providers to take an active role in QI.

The payer’s role in quality improvement is to enable the provider to improve quality through incentives and other structures that encourage and support QI.  CMS’ Medicare and Medicaid EHR Incentive Programs provide eligible professionals and hospitals financial incentives for demonstration of meaningful use of EHRs, which includes requirements for reporting on functional and clinical quality measures.  In addition, organizations that support quality improvement activities, such as the National Committee for Quality Assurance (NCQA) and the National Quality Forum (NQF), assist in developing standards and performance measures that inform the QI process.  Lastly, the role of public health professionals and policy makers is to create and support initiatives that promote quality improvement.

Related Resources:

Research Brief go to exit disclaimer- Center for Studying Health System Change
National Quality Forum go to exit disclaimer
National Committee for Quality Assurance go to exit disclaimer
Medicare and Medicaid EHR Incentive Programs - Centers for Medicare & Medicaid Services (CMS)

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