Quality of care assessment: policy relevant issues

This paper reviews the quality assessment literature, presents a study which compares five different methods of assessing quality of care, and proposes policy recommendations. Results are: (1) Most quality assessment issues are a century old. (2) The results of assessment of quality of care are dependent on the method used; therefore, more methodologic research is needed. (3) The use of lists of criteria, concerning what a physician does, to assess quality of care could result in decreased efficiency in the health system by requiring the performance of ineffective procedures. (4) It is not certain that examination of the level of care rendered will increase the health level of the population; therefore, any national program which assesses quality of care must be prospectively evaluated. (5) A quality assessment system must be concerned with both the population who received services at the institution, and the population who did not but for whom the institution is responsible.From the Carnegie-Commonwealth Clinical Scholar Program of the Johns Hopkins University.Supported in part by grants 5R01HS00110 and 5T01HS00112 from the National Center for Health Services Research and Development and by the Carnegie Corporation and Commonwealth Fund. Dr. Brook was a Carnegie-Commonwealth Clinical Scholar and is now a Commissioned Officer in the U.S. Public Health Service stationed at the National Center for Health Services Research and Development. This paper does not represent the official position of this agency.