Minnesota Administrative Rules

4685.1120 QUALITY EVALUATION STEPS.

Subpart 1.

Problem identification.

The health maintenance organization shall identify the existence of actual or potential quality problems or identify opportunities for improving care through:

A.

ongoing monitoring of process, structure, and outcomes of patient care or clinical performance including the consumer components listed under part 4685.1115, subpart 2, item C; and

B.

evaluation of the data collected from ongoing monitoring activities to identify problems or potential problems in patient care or clinical performance using criteria developed and applied by health care professionals.

Subp. 2.

Problem selection.

The health maintenance organization shall select problems or potential problems for corrective action or focused study based on the prevalence of the problem and its impact on patient care and professional practices.

Subp. 3.

Corrective action.

The health maintenance organization shall identify and document any recommendations for corrective action designed to address the problem. The documentation of corrective action shall include:

A.

measurable objectives for each action, including the degree of expected change in persons or situations;

B.

time frames for corrective action; and

C.

persons responsible for implementation of corrective action.

Subp. 4.

Evaluation of corrective action.

The quality assurance entity shall monitor the effectiveness of corrective actions until problem resolution occurs. Results of the implemented corrective action must be documented and communicated to the governing body and involved providers.

Statutory Authority:

MS s 62D.03; 62D.04; 62D.11; 62D.20

History:

14 SR 903

Published Electronically:

October 11, 2007