Quality assurance in medical care: lessons from the U.S. experience

by Robert H. Brook, Kathleen N. Lohr

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Describes the major developments in quality assessment and assurance in U.S. medical care, primarily as monitored by local Professional Standards Review Organizations (PSROs). For uncertain reasons, PSROs appear not to have produced hoped-for reductions in hospital stays or medical costs during their eight-year history, but hold promise as a means of improving quality of care. Improvement should be forthcoming as several issues are resolved, most of them having to do with specifying the system's goals, scope, targets, focus (e.g., patient curing or caring), and means of enforcement (e.g., physician incentives or direct regulation), and with measurement--of quality, health-provider performance, costs, and overall program achievement. Past research has highlighted numerous deficiencies in care, even for patients with commonplace illnesses; a persistent problem is ineffective communication of research results and PSROs' neglecting to exchange ideas and compare the local standards of quality they have established.

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