Texas medicine
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The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. ⋯ Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.
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The elderly population in the United States is increasing gradually. Estimates project that during the next 50 years 21% of the population, or approximately 70 million people, will be older than 65 years. Various medical and psychiatric disorders produce cognitive disturbances that result in temporary or permanent incompetence. ⋯ Problems exist related to obtaining informed consent from the elderly and distinguishing between incapacitated versus incompetent individuals. Physicians are responsible for providing information to their patients about a durable power of attorney for health care, a living will, and "do not resuscitate" orders, before they lose their capacity to make decisions related to their health care. Informed consent, living wills, durable power of attorney for health care, and guardianship are discussed.