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 guidelines. CSMC tracks how patients fare under a physician practice guideline through a number of analyses. These analyses include readmission rates, returns to the emergency department, the functional status of patients, and patients satisfaction (Pragner, 1996, p. 4).
Weingarten said that practice guidelines are most likely to be observed by physicians at CSMC when the guidelines computerized and provide reminders and warnings in "real-time" (Quoted in Pragner, 1996, p. 4). For optimal effectiveness, C...