Quality assurance and continuous quality improvement: history, current practice, and future directions.

Quality Assurance (QA) provides opportunities for physicians and allied health professionals to improve patient care and disease outcomes. Its goals are increased efficiency and efficacy in healthcare. QA activities are based upon objective criteria and systematic review and make important contributions to the effectiveness of hospitals and other care facilities. Successful programs help to maximize health status of patients while minimizing resource utilization. Beginning in 1917, early QA efforts were often informal and subjective but now include standards for QA and strategies for monitoring and evaluating patient care. Central to its new "Agenda for Change," the Joint Commission on Accreditation of Healthcare Organizations has embraced the concept of continuous quality improvement (CQI). This moves the focus of review away from department- or practitioner-specific activities and toward a "systems" form of evaluation. CQI is rooted in patient-care realities, is easy to implement, is based upon scientific assessments, and solves practical problems in an incremental and ongoing fashion.