Quality of Medical Care Assessment Using Outcome Measures

First in a series of three volumes, this report reviews the current state of the art of assessing the quality of medical care using the outcome method and describes in detail the approach taken during this year-long RAND research project to select outcome criteria and develop short-term, disease-specific outcome standards for eight disease conditions or surgical procedures: asthma in children and adults; breast mass and breast cancer; cholecystectomy; diarrhea and dehydration in children; ischemic heart disease; osteoarthrosis; otitis media in children; and tonsillectomy with and without adenoidectomy. Standards were developed by panels of physicians representing a variety of medical and surgical specialties and geographic areas. Although outcome measures have more face validity than do structure or process variables, the validity, reliability, and feasibility of the outcome approach are not assured. Recommendations are made for further testing of the standards developed and for additional research on the outcome method.