JLN Processes - Provider Quality Management - process
Process Group
Provider quality management
Objective
Ensure that the provider has delivered the necessary contracted quality of service
Input
Service-level agreement with provider
Clinical protocol and guidelines
Claims
Case notes
Patient records
Output
Quality review report
Quality rating
Update provider credentialing status
Measurable Outcomes
Re-admission rates
Infection rates
Caesarean section (c-section) rates
Decision on whether or not to contract for provider at a particular fee
Sources