The contribution of epidemiology to quality assessment and monitoring: a clear enough subject. But as I approached it, it slipped into ambiguity and confusion. What was quality assessment? What was monitoring? For that matter, what was quality? And the meaning of epidemiology was the deepest mystery of all.
I must begin by defining my terms. Quality shall be taken to mean making a judgment on the goodness of healthcare, based on one or more of the following: the expected or realized ability of the care to achieve the greatest improvement in health that the current science and technology of healthcare can achieve; acceptability to patients (including their families); and acceptability to the community (or the society at large). There are three ways in which we can find out if healthcare has been good in these respects. First is the examination of the process of care, which I take to mean the degree to which what is done for and by patients corresponds to what is known or believed to be most effective in improving health, and most acceptable to patients and to society. Second is the examination of the outcomes of care, meaning the degree to which the care provided is acceptable and has attained achievable improvements in health. Third is the examination of structural attributes, meaning the degree to which the physical and organizational settings in which care is given are conducive to the kind of care that can be expected to improve health and to be acceptable to patients and to the community. So much for quality assessment.