Washington has a number of quality improvement initiatives to provide better health care to its citizens.  The state has been charged with the development of quality assurance and improvement standards to be used in the uniform quality assurance program.  The purpose of the program is to protect the health of low income individuals and establish a floor of quality assurance standards.1  The Department of Health must also determine whether participation in the uniform quality assurance program by all health plans, health care providers, and health care facilities within the state is possible.2  All of those entities, except hospitals, may establish coordinated quality improvement programs.  The quality improvement programs may share information with quality improvement committees, peer review committees, quality assurance committees, and other coordinated quality care programs, as long as they comply with HIPAA.3  The final recommendations for the uniform quality assurance program must be a coordinated effort among the Department of Health, the Health Care Authority, Department of Social and Health Services, the Office of Insurance Commissioner, and Department of Labor and Industries.

        Local health departments are expected to evaluate the impact of increased public health spending on health outcomes by using performance measures.  These quality benchmarks include increases in childhood immunization rates, capacity to quickly contain disease outbreaks, and improvement in birth outcomes.4  In an effort to improve health care quality among children, The Washington State Health Care Authority must collaborate with the Department of Health, Department of Social and Health services, and interested stakeholders to create performance measures that show whether a child is enrolled in a medical home, and whether the overall health of the enrolled child is improving. The authority has discretion to choose performance measure topics, but should consider topics such as childhood immunization rates and emergency room utilization.5  In addition, the state requires the Department of Social and Health services and the “evidence-based practice institute” to develop outcome oriented performance measures to assess the effectiveness of the children’s mental health system.6

        All hospitals are also required to implement a coordinated quality improvement program.  The quality improvement program must have a committee, a grievance procedure, disciplinary process for practitioners, a system to collect negative health outcome data, and an educational program.7  Ambulatory surgery centers must also implement a coordinated quality improvement program with the same requirements as for hospitals.8  Ambulatory care facilities must also submit quality data to the Department of Health every eighteen months. The data must be used to evaluate the quality of care provided by the reporting facilities.9  Similarly, long term care facilities must implement a quality improvement system, which must meet a number of requirements.10  Further, the Department of Social and Health Services must develop and phase-in “a statewide internal quality review and accountability program for all residential care services.11  However, the requirement for the establishment of a quality assurance committee does not apply to nursing homes.  This is only something that nursing homes have the option to do.12