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The main purpose of this chapter is to review various methods for assessing quality of care and to summarize some of what is known about the current level of quality in the United States. The authors begin by considering criteria for selecting topics for quality assessment. Then they present a conceptual framework useful for organizing evaluation of quality. The definitions, methods, and state of the art in assessing the structure, process, and outcomes of care are subsequently discussed. The bottom line to this chapter is that scientifically sound methods exist for assessing quality and that they must be employed systematically in the future to guard against deterioration in quality that might otherwise occur as an unintended result of organizational and financial changes in the health services system.

Originally published in: Changing the U.S. Health Care System: Key Issues in Health Services, Policy, and Management, second edition, R. M. Andersen, T. H. Rice, G. R. Kominski, eds., San Francisco, Calif. : Jossey-Bass Inc., 2001, Chapter 7, pp. 150-182.

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