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HRD-84-22 1 (1984-02-24)

handle is hein.gao/gaobabngr0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 HUMAN RESOURCES DIVISION FEB 2 4 1984 Dr. Donald L. Custis 123497 Chief Medical Director Veterans Administration Dear Dr. Custis: Subject: Improvements Needed in Quality Assurance for Open Heart Surgery (GAO/HRD-84-22) We have reviewed the policies, procedures, and practices of the Department of Medicine and Surgery (DM&S) for assessing and assuring the quality of open heart surgery programs at Veterans Administration (VA) medical centers. We did not attempt to evaluate the quality of care, but concentrated on what DM&S did to ensure that quality care was provided to veterans in open heart surgery programs which did not meet the DM&S standard for the minimum number of operations or which experienced a relatively high mortality rate. DM&S relies on an expert committee of VA and non-VA physicians--the Cardiac Surgery Consultants Committee--to assess the quality of open heart surgery units where utilization is low or mortality rates are high. We found that DM&S has not required this committee to follow its guidelines regarding when the consultants would assess a program's quality and how the Committee would communicate the results of its assessments to the medical centers. DM&S also relies on the medical centers to assure that quality care is provided in their open heart surgery programs by using problem-oriented, systematic internal reviews, among other techniques. Two of the three medical centers we visited did not perform systematic internal reviews to assess the quality of care provided in their open heart surgery programs even when those programs had consistently low utilization and high mortality rates. (401935) 0 1/ /

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