[Methods of user participation in the evaluation and improvement of the quality of health services].

Involvement of consumers, the external customers of health services, in quality of care evaluation activities is increasingly regarded as a requisite for quality improvement programs. There are many but not mutually exclusive approaches to incorporate consumer participation to quality improvement activities. This paper reviews the main characteristics, and potential usefulness and pitfalls of the more common approaches. Participation methods are grouped in two groups: those actively decided and initiated by consumers (i.e. complaints, choosing providers, consumers' associations initiatives, etc.), and those requested by providers (i.e. satisfaction and expectations surveys, patients' reports, etc.). Given that requested consumer involvement may constitute a key element in quality improvement programs, special attention is paid to critically analyzing its methodological implications.