URAC Core 37 -- Clinical, Error Reduction, and Consumer Safety Requirements

One of the areas in which the new emphasis on error reduction and consumer safety is Core 37:

Core 37 – Clinical, Error Reduction, and Consumer Safety Requirements
At any given time, the organization maintains no less than two quality improvement
projects.
(a) At least one quality improvement project that:
(i) Focuses on consumers; or for organizations who do not interact with
consumers, client services;
(ii) Relates to key indicators of quality as described in 34(c); and
(iii) Involves a senior clinical staff person in judgments about clinical aspects of
performance, if the quality improvement project is clinical in nature; and
(b) At least one quality improvement project focuses on error reduction and/or
consumer safety.
(i) Consumer safety QIPs are required of the following programs: HUM, WCUM,
HCC, HP, DM, IRO, and CM.
(ii) Error reduction QIPs are required of all accreditation programs that do not
conduct consumer safety QIPs.

There are a few key things to keep in mind about this standard and the quality improvement programs (QIPs) it mandates:

• URAC reviewers will interview the senior clinical staff person to assess his/her involvement in clinical judgments (subsection (a)(iii)).
• The requirement for patient safety applies only to certain modules (HUM, WCUM, HCC, HP, DM, IRO, and CM). All the rest of the clinical programs can use an error reduction QIP.
• A good place to look for ideas for QIPs are barriers to proper medical management, use of current triage guidelines, integration of quality information, patient access issues, sentinel events tracking, etc.
• Make sure the baseline and goals are measurable, and in the same units.
• Make sure your goal is connected to a target date for achievement.