Developing outcome standards for quality assurance activities.

When quality assurance programmes began to develop actively, 20 or so years ago, information connecting outcome and process was very scanty. However, with the development of the field of health care technology assessment, there is now much information on efficacy that has not been applied in the field to improve quality. At the same time, patient's satisfaction with care is coming to be seen as a valid measure of outcome of care. On the other hand, process measures of quality developed by practitioners working with a particular problem are often of doubtful validity, and could even be harmful. Increasingly, quality assurance programmes will be based on outcomes of care, or on process measures that have been linked clearly to outcome. Informatics can contribute to quality assurance in two ways. One is in the development of information on efficacy and safety of care through data banks, such as those reporting hospital death rates or insurance claims data. The other is to monitor outcomes of care directly. Up until now, technology assessment and quality assurance have developed as largely independent activities. A constructive approach to developing systems of quality assurance would be to incorporate technology assessment as part of the development of guidelines for quality assurance programmes.