Current Issues in Quality of Care

Prologue: Defining the quality of medical care seems to be almost as elusive as measuring it In any event, there is no question that the issues surrounding quality touch on a wide variety of questions that impinge on the future configuration of America's health care system. In this overview paper, Kathleen Lohr, Karl Yordy, and Samuel Thier explore these issues, many of which are discussed at greater length in subsequent papers. Lohr, who holds a doctorate in public policy analysis from The RAND Graduate School, is a senior professional associate at the National Academy of Sciences Institute of Medicine (IOM) with responsibilities in several areas, including directing a new study of quality of medical care and participating actively in the IOM's Council on Health Care Technology. Previously, Lohr spent twelve years at The RAND Corporation and was heavily involved in its landmark health insurance experiment Yordy, who holds degrees from Princeton and Harvard universities, is director of the IOM's Division of Health Care Services. He joined the institute in its inaugural year (1972) and has been involved in a variety of IOM studies, including most recently directing an IOM committee that examined “The Future of Public Health.” Thier, formerly chairman (1975–1986) of the Department of Internal Medicine at Yale Medical School, is the president of the IOM. As the institutes chief executive officer since January 1987, Thier has energized the organization by raising substantial new resources, significantly expanding its staff, and involving the quasi-public enterprise in a wide variety of studies. One of these projects is the newly launched study of issues surrounding the quality of care. The study, which is supported financially by the Health Care Financing Administration, was mandated by Congress in the Omnibus Budget Reconciliation Act of 1986. The emphasis of the study will be on influencing future directions of quality assessment and assurance by seeking to better define the terms and developing tools to measure quality more effectively.