Medical care classification systems in the ambulatory care environment: an evaluative framework.

An essential need of a Quality Assurance Program (QAP) in an ambulatory care setting is accurate and reliable information characterizing the encounter between patient and provider. This information includes identification of the patient's reason for visit, the provider's diagnostic impressions, and procedures performed. Such data can be used to maintain an informational index on the nature of patient care. Based upon this index, a wide variety of special studies in the assessment and assurance of the quality of care can be conducted. A primary consideration in the development of such an index is the choice of a Medical Care Classification System (MCCS) to be used to code encounter-related data. The objective of this paper is to provide a methodology and evaluative framework in which available Medical Care Classification Systems can be assessed as to which one best meets the needs of the quality assurance programs within ambulatory care settings.