Medicare: a strategy for quality assurance, II: Site visits.

The second of a series of articles on the Institute of Medicine study on a quality review and assurance program for Medicare, this article recapitulates the findings of site visits conducted between October 1988 and May 1989. The issues and concerns raised by site visit hosts, as listed in the IOM report, are discussed in detail. For example, concerns about QA methods include those regarding the duplication of quality review and assurance efforts, the value of education and feedback of quality-of-care information, disclosure, dealing with the very poor practitioner, and improving average practice. Most problems of quality and QA identified by the organizations visited are those of "systems" rather than individual providers, which itself is an important finding.