SPC in Managed Health Care


Lighter, Donald E.   (1999, ASQ)   BlueCross/BlueShield of Tennessee

Quality Management Conference, Charlotte, NC    Vol. 11    No. 0
QICID: 18917    January 1999    pp. 1-7
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Article Abstract

[This abstract is based on the author's abstract.] Disease management (DM) has been identified by medical experts as the premier method of influencing the cost and quality of health care in 21st Century. DM programs have shown the best results when they promote access to preventive care services and the poorest performance when they attempt to reduce variation. As physicians have become busier and treatment plans more complex, the ability of an individual physician to manage dozens of treatment plans simultaneously has been compromised. Additionally, physicians can usually only recommend specific treatment or diagnostic interventions, while insurers exercise leverage in gaining patient cooperation by offering insurance coverage incentives to encourage use of preventive services. Thus, insurance companies have assumed many disease management responsibilities. The DM process borrows directly from quality improvement methodologies that have been successfully applied in American industry for nearly 50 years. This approach emulates the PDSA cycle, and QI tools are utilized at each step in the process. Results of interventions can be tracked and the quality of care is gradually being improved using these methodologies.


Health care,Plan-Do-Check-Act (PDCA) cycle,Statistical process control (SPC),Quality management (QM),Quality Improvement System (QIS)

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