External quality improvement: Accreditation, certification, and education

Abstract

We define external quality improvement as the review of a physician or healthcare organization's performance by an external or outside body. Some external review systems have a legal statutory basis and are mandatory, while others are voluntary in nature. Their ultimate goals are to review, evaluate, and rank healthcare organizations based on explicit standards and measurements which can result in significant financial or nonfinancial incentives and sanctions. Legislative and regulatory mandates, market demands for accreditation by consumer groups and payers, and quality improvement efforts by healthcare providers are the backbone for external quality improvement and define the critical role played by these accrediting organizations in the certification of quality in healthcare. This chapter presents information on external quality improvement programs and organizations, including their most recent reports and updated changes and the effect they have on the accreditation and education processes.