Medical institution evaluation is the process of assessing the quality of medical care. This is done, for instance, to determine whether a physician’s care conforms to the standards of practice set by the profession. This is a very complex process, however, and the conclusions drawn from it must be taken with great caution. 위너넷
The main goal is the assessment of the appropriateness, completeness and redundancy of information obtained through clinical history, physical examination and diagnostic tests; justification of diagnosis and therapy; technical competence in the performance of diagnostic and therapeutic procedures, including surgery; evidence of preventive management in health and illness; coordination and continuity of care
; acceptability to the recipient and so on. In order to achieve this aim judgments of quality depend on agreement among physicians concerning facts and values. They may also be influenced by parochial standards and criteria of practice that develop in and around certain institutions or “schools” of medical practice.
Direct observation of the patient’s condition and the managing physician’s activities in an inpatient or outpatient setting has been used to assess the quality of the latter. But the difficulty of obtaining all possible information from this source is not eliminated by this method, because the managing physician knows a great deal about the patient from previous contacts and has a wide range of activities to perform in the course of care. 위너넷
One can, of course, use other methods, such as interviews with the patients themselves or by questionnaires. But these are a rather less reliable means of judging the quality of medical care than direct observation. The same can be said of abstracts of office records, which may be more accurate but which cannot be generalized as a means of assessing the quality of medical care in any given medical situation.
Another problem is that of the all-or-none aspect of medical care, which a numerical score, even in very close agreement, cannot reflect. This can occur because of the way in which medical technology is not fully effective or because of the many different factors that influence the outcome.
Therefore, it is not surprising that a number of attempts have been made to develop more exact means of determining the quality of medical care. These include the adoption of normative standards; the use of experience in the best hospitals to derive a corrective factor; and the use of a combination of these approaches.
These methods have been adopted not only in the specialized arena of hospital centered and academically oriented medicine but also in the field of ambulatory practice, which has not always been easy to evaluate.