A. Definitions Scope of Care/Services-a facility shall delineate their scope of practice to include:
a. the range of services provided, including conditions prevented, managed, or treated;b. treatments and/or procedures provided;c. patient populations served;d. hours when care or services are provided; and,e. types of professional disciplines and/or specialists providing services.Evaluation-the review and assessment of the quality and appropriateness is an important aspect of care. The review and assessment is designed to identify problems and develop procedures to prevent and resolve the problems.
Important Aspects of Care-clinical activities that involve a high volume of patients, that entail a high degree of risk for patients, or that tend to produce problems for staff or the patients are deemed most important for purposes of monitoring and evaluation.
Monitoring-a process of surveillance, and/or auditing to identify systemic or localized problem area(s) where improvement may be indicated.
Performance Indicators-the measurement tool used to monitor and evaluate the facility's quality of management, clinical services, and support functions.
Pursuit of Opportunity to Further Improve Care-applies pro-active efforts to identify and implement improvements.
Quality Improvement-a management led and patient focused systematic method of improving systems and processes. Its basis is a statistical process control.
Quality of Patient Care-the degree to which patient care services increase the probability of desired patient outcomes and reduce the probability of undesired outcomes.
B. Purpose 1. Utilization Review. The purpose of the review is to determine whether:a. the utilization of services are appropriate;b. the established policies are followed; andc. if any changes are needed.C. Process 1. Rural health clinics shall carry out, or arrange for, a biennial evaluation of its total program.2. The evaluation shall include review of: a. utilization of the RHCs' services, including at least the number of patients served and the volume of services; andb. a representative sample of both active and closed clinical records; andc. the RHC's health care policies.D. Quality Assurance/Continuous Quality Improvement. The RHC shall have ongoing programs to assure that the overall function of the clinic is in compliance with federal, state, and local laws, and is meeting the needs of the citizens of the area, as well as attaining the goals and objectives developed from the mission statement established by the RHCs.La. Admin. Code tit. 48, § I-7529
Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 25:1851 (October 1999), Amended by the Department of Health, Health Standards Section, LR 501280 (9/1/2024).AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2197.