SECTION 310:657-5-2. 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.

[Source: Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96]