Reviewing the quality of care: Priorities for improvement

Rapid and substantial change in our health care system has prompted careful analysis of the quality of health care and the effectiveness of the methods used to review and improve quality. Although welcome, those applying this scrutiny must recognize that improvement in the quality of health care will take the concerted and cooperative efforts of health policymakers, health care practitioners, health care organizations, consumers of care, purchasers of care, and those organizations that define the state of the art and monitor the quality of care. Particular attention should be devoted to: • Gaining a common understanding of the definition of high quality care. • Utilizing review programs that are continuous, priority-oriented, and effective. • Assuring that the indicators and criteria used in monitoring care are consistent with the practical state of the art. • Recognizing the importance of and improving the effectiveness of peer review. • Investing in improved diffusion of current clinical knowledge to practitioners. • Being properly circumspect about how one best achieves improvement in areas of substandard care.