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February 17, 1975

The Tyranny of Standards

Author Affiliations

From the Health Services Research Center at Interstudy, Minneapolis.

JAMA. 1975;231(7):709-710. doi:10.1001/jama.1975.03240190013008

IMPROVING medical care quality is a goal shared by the physician, the patient, and the bill payer. The ability to do so first of all, implies knowledge of the current quality of care level, and second, existence of mechanisms to alter substandard conditions. Quality has been defined as "the degree of adherence to a standard," and assessing the quality of medical care generally involves comparing actual care with some standard or criterion of excellence. Differences between the real and the stated ideal are then analyzed and deficiencies identified. Improved quality is determined by increased compliance with standards at the time of reassessment.

We are rapidly being surrounded by standards or criteria designed for use in determining the necessity of hospital admission, appropriateness of medical service utilization, and quality of care. Criteria sets are being prepared by professional specialty societies, foundations for medical care, and experimental medical care review organizations. The