Quality Assurance at Cedars Sinai Medical Center

QUALITY ASSURANCE AT CEDARS SINAI MEDICAL CENTER

This research assesses the quality assurance program at Cedars Sinai Medical Center (CSMC). CSMC, in Los Angeles, is recognized as a state-of-the-art medical center (Levine, 1993, p. 63). The institution is a large teaching and community hospital serving West Los Angeles.

With a fee-for-service (FFS) institutional culture in the first-half of the 1990s, however, CSMC recognized that the future of health care in the United States was moving toward the managed care concept, and that the institutional culture required a reorientation toward a greater reliance on the IPA (independent provider agency) and PPO (preferred provider organization) concepts (Harris, 1993, p. 5). Each of these concepts demands that a health care provider assure that high-quality care is delivered.

Quality assurance management at CSMC was implemented within the context of physician practice guidelines and treatment outcome tracking (Pragner, 1996, pp. 3-4). Scott Weingarten, Director of Health Services Research at CSMC, said that physician compliance with a guideline is dependent upon the level of confidence held by the physician that the guideline will lead to improved care outcomes for patients (Quoted in Pragner, 1996, p. 4). To promote physician compliance with practice guidelines at CSMC, a treatment outcome tracking system was developed and implemented to document the effectiveness of the gu

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mes, patient satisfaction, and health care costs as part of a controlled interventional trial. Physicians were offered the option of using the guideline to complement their clinical judgment or rejecting the guideline, with this decision left to the discretion of the treating physician (Weingarten & Ellrodt, 1995, p. 20). After implementation of the guideline, health care related to chest pain became more efficient at CSMC. Total costs, including both direct and indirect costs, were reduced by more than $1,000 per patient. Further, the patient complication rate and the mortality rate were very low, and excellent patient outcomes were achieved. Lastly, an overwhelming majority of patients were satisfied with the medical care and expressed a willingness to return to the hospital in the future if necessary (Weingarten & Ellrodt, 1995, p. 20). Knee Replacement Guideline The physician practice guideline for total knee replacement was developed at CSMC through the consensus of two board-certified orthopedic surgeons and a board-certified general internist (Weingarten, Conner, Riedinger, Alter, Brien, & Ellrodt, 1995, p. 27). A two-stage process was used to identify and classify patient complications. In the first stage, the dat

Category: Medical - Q