The development of this section of Infection Control and Hospital Epidemiology was stimulated by the opportunity and the need to expand the activities of those practicing epidemiology in the hospital “beyond nosocomial infections to the rates, distributions, preventive measures, and cost benefit studies of all adverse events in patients.” Some of the most compelling opportunities to do so involve the hospital's quality assessment (QA) and utilization review (UR) activities.
The hospital can reap considerable benefits from the involvement of an epidemiologist in the QA/UR program. Assistance in study design, sampling techniques, data management, and statistically sound analysis can be invaluable. Furthermore, in the process of providing consultation, the epidemiologist is training the QA staff in the epidemiologic approach to data. Involvement of an epidemiologist (particularly a physician epidemiologist) in the QA program can increase the confidence of the medical staff in the validity of the data presented to them and enhance their willingness to act in response.
Although QA programs must be responsive to the requirements of many external entities, for the majority of hospitals, the most detailed and demanding applicable standards are those set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and published annually in the Accrediting Manual for Hospitals. Fundamental to many of these standards is the process known as “monitoring and evaluation.”