Quality Assurance and Effectiveness in Health Care: An Overview

Increasing interest in quality assurance and effectiveness in health care has been generated by three major observations: about 20% of care is consistently demonstrated to be inappropriate, variations in practice cannot be explained be patient or facility factors, and decreased utilization as a result of changing economic and regulatory incentive seems to lead to both inappropriate care and appropriate care reductions. This interest has led to at least three changes in the approach to quality assurance. First, there has been a move from measuring practitioner competence to measuring population health outcomes. Second, the use of implicit judgements has declined while the importance of explicit standards (eg. practice guidelines) and explicit process in establishing standards has increased. Third, greater efforts have been made to lessons the organizational isolation of quality assurance and to integrate it into everyday activities and across the levels of health- care delivery.