Assessment of ambulatory care: application of the tracer methodology.

Utilizing a tracer method in the assessment of care was investigated in a large pediatric clinic. A set of tracers were selected and agreement was obtained concerning the relevance of care criteria by at least 80 per cent of the facility physicians. One tracer, iron-deficiency anemia, was studied using two nonphysician abstractors to review a sample of 100 patient records with hemoglobins of 11.0 gm/100 ml or less. Results were compared with an implicit review by a panel of physicians. In 52 patients, the low hemoglobin level was not recognized. Only 25 patients proceeded through the care levels of evaluation, diagnosis, treatment, and follow-up. Poor compliance was found with the approved criteria. Weighted scores of the explicit tracer method were closely related to ratings by the implicit reviewers. Utilizing tracer assessment with nonphysician abstractors demonstrated remediable deficiencies in health care services.