| Sumario: | Part of a special section on health-care service delivery in an evolving managed care environment. The writers discuss Virginia's Quality Assessment and Improvement (QA/I) program for Medicaid, which was adapted from the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration. The QA/I program uses three operational assessment components: practice parameter profiles of the outcomes for sentinel conditions seen by primary-care physicians, detailed chart reviews for selected areas of care, and a household survey of 1,500 patients on health and on satisfaction with and access to care. In its implementation of the adapted QARI guidelines, several limitations were encountered by the state. Despite this, the QARI approach is a starting point for states to begin assuring Medicare quality and efficiency.
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