Process Group

Provider quality management

Objective

Ensure that the provider has delivered the necessary contracted quality of service

Input

• Formulary

• Service-level agreement with provider

• Clinical protocol and guidelines

• Claims

• Case notes

• Patient records

• Complaints

Output

• Quality review report

• Quality rating

• Update provider credentialing status

Measurable Outcomes

• Re-admission rates

• Mortality rates

• Infection rates

• Caesarean section (c-section) rates

• Decision on whether or not to contract for provider at a particular fee

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf