The Quality of Care and the Quality of Measuring It

Underlying the expectation that physicians, health plans, and other organizations will soon be competing on the basis of the quality as well as the cost of medical care1 is the fundamental assumption that we know what quality is and how to measure it, monitor it, and ensure it. This is a proposition devoutly to be wished, and one to which millions of dollars will be devoted. But how accurate is it?A large industry is developing standards of quality against which physicians and health care organizations will be judged. These standards, or practice guidelines, are based on existing controlled clinical . . .