Outcome Assessment 70 Years Later: Are We Ready?

AT the beginning of this century, a distinguished Boston surgeon, Ernest Amory Codman, waged a courageous but unsuccessful campaign to have surgeons and hospitals record and publicize the results of their operations. Some seven decades later, the Joint Commission on Accreditation of Hospitals (JCAH) has announced its intent to include outcome criteria as part of its accreditation procedures for hospitals in the United States. Until now, the commission has relied on structure and process criteria to assess the quality of care. In examining structure, JCAH reviewers check the existence, for example, of monitoring equipment in operating rooms, the adequacy of . . .