Stevens & Lee, Lancaster, PA 17602, United States.
Best Pract Res Clin Gastroenterol. 2011 Jun;25(3):409-17. doi: 10.1016/j.bpg.2011.05.011.
Quality assurance data - essential to successful efforts to improve the quality and efficiency of healthcare - is more important than ever in today's environment. Robust quality assurance activities are required to achieve the accreditation necessary to obtain Medicare reimbursement and for participation in the Accountable Care Organization shared savings programs proposed by the Centers for Medicare and Medicaid Services ("CMS"). The federal government and US states require reporting of quality assurance data to a variety of independent and governmental agencies. Commercial insurance carriers and innovative employers are developing new reimbursement models that require demonstrable achievement of quality performance standards based on quality performance data. Such data can consist of both aggregate performance information and individualized outcomes. This chapter reviews the potential vulnerabilities of quality assurance programs and data and the legal concerns related to disclosure of the information. Available legal protections and some effective strategies for protecting that information are also discussed. This information will enable providers to develop effective quality assurance programs structured to maximize opportunities to protect the confidentiality of the data.
质量保证数据——对于提高医疗保健质量和效率的成功努力至关重要——在当今环境下比以往任何时候都更加重要。为了获得医疗保险报销和参与医疗保险和医疗补助服务中心（“CMS”）提出的问责制医疗组织共享储蓄计划，需要进行强有力的质量保证活动。联邦政府和美国各州要求向各种独立和政府机构报告质量保证数据。商业保险公司和创新型雇主正在开发新的报销模式，要求根据质量绩效数据证明达到质量绩效标准。此类数据可以包括总体绩效信息和个体结果。本章审查了质量保证计划和数据的潜在漏洞，以及与信息披露相关的法律问题。还讨论了可用的法律保护措施和一些保护信息的有效策略。这些信息将使提供者能够制定有效的质量保证计划，以最大限度地保护数据的机密性。
