The role of patient interventions in ambulatory quality assurance programs.

This paper highlights several studies conducted by a quality assurance research program in a health maintenance organization which provide tangible support for the need to integrate patient interventions with quality assurance activities. A model for quality assurance is described which proposes to include identification of the role of patient behavior in affecting health outcomes, and to develop intervention mechanisms directed towards patients. The experiences from this investigation suggest the need to add patient interventions to the traditional quality assurance efforts of affecting system and provider behaviors. Four of the ten projects conducted are described to illustrate these issues. Topics reviewed are maternity care, hypertension, management of breast disease, and pap smears for high-risk women. These recommendations are particularly appropriate for health maintenance organizations since both quality assurance and health education programs are mandated in the 1973 HMO Act. However, these findings are of relevance to other ambulatory care settings as well.