Continued Evolution of a System of Medical Care Appraisal

The quality of personal medical care is compounded of two elements: that level of excellence produced and documented by a process of diagnosis and therapy, both preventive and curative, based on the best knowledge derived from science and the humanities; and that which eventuates in the least morbidity and mortality in a population. Urging comes from Charles L. Hudson, MD, past President of the American Medical Association and John Porterfield, MD, director of the Joint Commission for Hospital Accreditation, and many thoughtful physicians in positions of leadership for evidence of the professional exercise of responsibility in critical appraisal of the quality of medical care. Others, including the President of the United States, express concern and suggest that rising costs of medical care can be arrested without sacrificing the quality of medical care. Many thoughtful essayists and investigators, such as Avedis Donabedian, MD, 1 C. W. Eisele, MD, and Virgil Slee,