Brook R H, Williams K N, Avery A D
Ann Intern Med. 1976 Dec;85(6):809-17. doi: 10.7326/0003-4819-85-6-809.
We review here the definition, history, and current findings of quality assessment. Difficulties with quality assessment center principally on methods problems, including using the medical record as a source of information, using process versus outcome criteria, and ignoring decision analysis methods in establishing quality criteria. One overriding issue is placing a value on health and, by extension, on quality assurance and assessment efforts; another is the degree to which improvements in the quality of care can be achieved through changes in physician practices. Several sets of recommendations address these topics. With the assumption that such recommendations could be acted on in a transition period, a hypothetical quality assurance system is described for the 1980s and beyond. This system is based on preservation of the fee-for-service system, adoption of a national health insurance plan, and minimal federal involvement in quality of care decisions at the regional level.
在此，我们回顾质量评估的定义、历史及当前研究结果。质量评估的难点主要集中在方法问题上，包括将病历作为信息来源、采用过程标准与结果标准，以及在确立质量标准时忽视决策分析方法。一个首要问题是对健康进行估值，进而对质量保证和评估工作进行估值；另一个问题是通过改变医生的行医方式能够在多大程度上实现医疗质量的提升。有几套建议涉及这些主题。假设这些建议能够在过渡时期得到实施，本文描述了一个适用于20世纪80年代及以后的假想质量保证体系。该体系基于保留按服务收费制度、采用全国医疗保险计划，以及联邦政府在地区层面尽量减少对医疗质量决策的干预。
