Assessing Quality of Care from the Medical Record

Abstract Quality of medical care may be assessed on the basis of either the outcome of care or the process by which the care was given. To compare these two criteria, records and outcome were studied of patients with two common conditions, appendicitis and myocardial infarction. In three different hospitals the records of patients with the diagnosis of acute appendicitis had considerable disparity in the frequency of documentation of commonly sought symptoms or signs of this condition; yet at each hospital the disease was diagnosed with the same accuracy. Similarly, recorded data of patients with acute myocardial infarction showed no relation to various outcomes, including length of time lost from work, occurrences of angina, congestive heart failure, myocardial reinfarct and death. Thus, the orthodox method of audit for quality of medical care, based upon chart review of the recorded process of care, may be incomplete and misleading.