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By J. Kaffu. University of North Alabama. 2017.

The ultimate goal of the Joint Commission initiatives is to be able to offer uni- form aggregated results that can be compared across all hospitals buy minomycin 50 mg without prescription. To fur- ther establish the credibility of these measures buy minomycin 50mg, the Joint Commission has 94 The Healthcare Quality Book joined into a collaborative arrangement with CMS, the American Hospital Association (AHA), and a number of state hospital associations to collect and share the Core Measures results. This is seen as a positive step, since it is an attempt to minimize the burden of data collection being placed on hospitals and work toward a common MDS that can serve numerous pur- poses. Since this collaboration is still new, however, the exact details of how the data sharing will work need to be finalized; the value-added contribu- tion of the collaborative remains to be seen. Its primary purpose is to accredit health plans, primarily health mainte- nance organizations (HMOs) and preferred provider organizations (PPOs). But NCQA has also been involved with developing measures of quality and certification standards for individual physician offices, large medical groups, disease management entities, and credentialing organizations. Far fewer PPOs have gone through the accreditation process, basically because the PPO accreditation process was initiated in 2000 and it takes several years to gear up for a suc- cessful accreditation review. The NCQA Health Plan Report Card is the primary reference for large companies and other organizations interested in evaluating which health plans to offer to their employees. The Health Plan Employer Data and Information Set (HEDIS) is the MDS that NCQA has created to evaluate the quality of care and customer service provided by each health plan. The HEDIS data elements include quality of care, access to care, and member satisfaction with the health plan and the doc- tors they see. Providers are being asked to document what they do, evaluate the outcomes of their efforts, and then be prepared to share their results with the public. Unfortunately, many providers struggle to proactively address the measurement mandate. This leads organizations to assume a defensive posture when their data are released. In such cases, the usual responses by the provider include the following: • The data are old (one to two years, typically) and do not reflect our current performance. The Search for A Few Good Indicators 95 • The data are not stratified and do not represent appropriate compar- isons. While these responses frequently have some degree of merit, they are generally regarded, especially by those who release the data, to be feeble excuses and attempts by providers to justify their current ways of delivering care. A more proactive posture would be to develop an organiza- tionwide approach to quality measurement that meets both internal and external demands.

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It is and other substances to all body cells and to remove waste much more muscular and thick walled because it contracts products of cell metabolism (carbon dioxide and others) discount 100mg minomycin with amex. A muscular wall called the septum separates the right the quality and quantity of blood buy minomycin 50mg overnight delivery. HEART Layers The heart is a hollow, muscular organ that functions as a two- The layers of the heart are the endocardium, myocardium, and sided pump to circulate five to six liters of blood through the epicardium. It is continuous with the endothelial lining of blood described in the following sections. The myocardium is the strong muscular layer of the heart that provides the pumping power for circulation of blood. The right atrium receives de- oxygenated blood from the upper part of the body by way of Valves the superior vena cava, from the lower part of the body by way of the inferior vena cava, and from veins and sinuses within the Heart valves function to maintain the one-way flow of blood heart itself. The mitral valve separates the left 739 740 SECTION 9 DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM atrium and left ventricle. The tricuspid valve separates the muscle functions to maintain blood pressure and blood flow. The pulmonic valve separates It contracts and relaxes in response to numerous stimuli, in- the right ventricle and pulmonary artery. Overall, regulation of tone in vascular smooth muscle depends on the intracellular con- Conduction System centration of calcium ions. There are several mecha- The heart contains special cells that can carry electrical im- nisms by which calcium ions can enter the cell. This Endothelial cells, once thought to be passive conduits for special conduction system consists of the sinoatrial (SA) blood flow, are now known to perform two extremely impor- node, the atrioventricular node, bundle of His, right and left tant functions in maintaining homeostatic processes. The SA node, the nor- function is structural, in which the cells act as a permeability mal pacemaker of the heart, generates a burst of electrical barrier and regulate passage of molecules and cells across the energy approximately 60 to 100 times each minute under nor- blood vessel wall. The electrical current flows over the heart the cells secrete opposing mediators that maintain a balance in an orderly way to produce contraction of both atria, then between bleeding and clotting of blood (including activation both ventricles.