Evaluating the Quality of Medical Care

This paper is an attempt to describe andevaluate current methods for assessing the quality of medicalcare and to suggest some directions for further study. It is con-cerned with methods rather than findings, and with an evaluation of methodology in general, rather than a detailed critique of methods in specific studies. This is not an exhaustive review of the pertinent literature. Certain key studies, of course, have been included. Other papers have been selected only as illustrative examples. Those omitted are not, for that reason, less worthy of note. This paper deals almost exclusively with the evaluation of the medi-cal care process at the level of physician-patient interaction. It excludes, therefore, processes primarily related to the effective delivery of medi-cal care at the community level. Moreover, this paper is not concerned with the administrative aspects of quality control. Many of the studies reviewed here have arisen out of the urgent need to evaluate and control the quality of care in organized programs of medical care. Nevertheless, these studies will be discussed only in terms of their contribution to methods of assessment and not in terms of their broader social goals. The author has remained, by and large, in the familiar territory of care provided by physicians and has avoided incursions into other types of