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To the Editor.—
Methinks Dr Rosenberg doth protest too much (237:1935, 1977). His advocacy of "process" audit would be admirably suited to ensure that the contemporaries of Dr Benjamin Rush bled off the proper amount of blood or gave the correct number of purgatives to their yellow fever patients. It would serve well in China today to be certain that needles of the correct size were inserted into the proper places, together with the right concoctions of herbs for the management of kidney stones. It would ignore the basic evaluative question—how much good did all these things do?The PEP is directed toward an answer to this question. That it does not go all the way is because "outcomes" take time to emerge. Dr Rosenberg criticizes PEP because it does not answer outcome questions about hysterectomies and the treatment of tracheobronchitis. Process evaluators never even bother to ask the questions.
Roth RB. Medical Audit JCAH-Style: A Positive View. JAMA. 1977;238(6):479. doi:10.1001/jama.1977.03280060023006
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