Quality assessment and quality improvement

(a) The Plan, either directly or through contract, shall maintain a quality assessment and improvement system. The system shall have at least these features: (1) Systematic collection and analysis of data, including measures of provider performance; and (2) Activities to foster continuous improvement of services provided to injured workers, including: (A) identifying practices which result in positive health outcomes; and (B) integrating information sources such as service management, claims processing, worker satisfaction and grievances. (3) Organizational support for the system with input from the medical director; (4) Methods of evaluating performance improvement activities. (b) The quality assessment and improvement system shall include the following functions, done at least annually: (1) An analysis of care patterns in the following priority areas: (A) Services likely to affect many injured workers; (B) Procedures that could place the health of injured workers at risk; (C) Variations in practice patterns; and (D) Underuse and overuse of medical and health services; (2) An evaluation of access to medical and health services. OAC 310:657 OKLAHOMA STATE DEPARTMENT OF HEALTH