Quality assurance for health supervision of the ambulatory child.

The Joint Committee on Quality Assurance (JCQA) was established in 1970 by the American Academy of Pediatrics and includes members from eight organizations concerned with primary care for children. The Committee developed criteria for assessing (1) health supervision of children, and (2) the management of three common diseases of children: tonsillopharyngitis, urinary tract infection, and bronchial asthma. These criteria were then validated by 452 academic and practitioner experts. A representative sample of primary care physicians further evaluated these criteria. The last phase of the study consisted of an audit of charts in the offices of pediatricians, family physicians, and general practitioners to determine the applicability of these criteria to medical records. Good agreement on health supervision criteria was found between academic and practitioner experts. Recording practices of pediatricians and other physicians were quite similar in the representative sample, although pediatricians recorded more complete health supervision information than did family physicians and general practitioners in the office audit. Present chart systems and recording practices do not allow meaningful peer review by chart audits in most office settings.