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August 8, 1977

Medical Audit JCAH-Style: A Negative View

JAMA. 1977;238(6):479. doi:10.1001/jama.1977.03280060023004

To the Editor. —  Although his "Negative View" comes from too narrow a perspective, the central point of Dr Rosenberg's article (237:1935-1937, 1977) is hard to deny. The Joint Commission for the Accreditation of Hospitals (JCAH) has been napping, and Dr Rosenberg has caught them at it. The JCAH's too narrow definition of "outcome" is one reason that Patient Care Audit/Medical Care Evaluation still consists of two camps: the "processors" and "outcomers," who spend more time debating which approach is correct than in developing meaningful studies of patient care.Everything in Dr Rosenberg's article cannot be accepted without clarification, but his last two paragraphs are unarguable. He suggests that our whole preoccupation with medical quality control is "premature" until we have "substantially more verification" of what constitutes optimal practice, and that our best chance of getting such information is from a "properly constructed audit that could provide adequate data for