August 13, 1997

Are "America's Best Hospitals" America's Best?

Author Affiliations

Medical Care Management Corporation Bethesda, Md

JAMA. 1997;278(6):474. doi:10.1001/jama.1997.03550060050024

To the Editor.  —In their timely and creative article, Dr Green and colleagues once again draw our attention to the serious paucity of meaningful assessments of the quality of hospital care—specifically, the dearth of systems to assess care processes—and the lack of effort devoted to them.1 Almost 150 years ago, Florence Nightingale understood the principles necessary to measure the quality of hospital care.2 Almost 100 years ago, Codman pointed out that the lack of incentives to assess quality results in the lack of quality assessments.3 They lacked the technology to validly assess the quality of care. Today, the necessary computer-based technology exists, and its application at little cost will become routine when electronic medical records become the norm.Practical quality assessment and quality improvement depend on comparing care processes that should have been applied to improve a particular patient's health status (a global measure of the health quality of life)