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September 16, 1998

Quality-of-Care Research: Internal Elegance and External Relevance

Author Affiliations

From the Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.

JAMA. 1998;280(11):1006-1008. doi:10.1001/jama.280.11.1006

Much of quality assessment is based on approaches that have been around for the better part of the 20th century. Even the focus on outcomes dates back more than 80 years to the exhortations of Ernest Codman.1 The inclusion of patient opinion is not new either; consumerism dates back almost half a century and the literature on consumer attitudes and satisfaction has a long history.2 The President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry spent more than a year discussing the challenges. Its report made more than 50 recommendations to "advance the purposes of continuously reducing the impact and burden of illness, injury, and disability and to improve the health and functioning of the people of the United States."3 These recommendations focused primarily on using the results of research to improve patient care, as well as building an "ongoing research agenda and capacity for achievement."