Appropriateness of care: the case for changing the focus of "quality" measurement

"Quality" of care has become one of the main foci of the American health care system during the last 20 years. As costs escalated in all areas of health care, the purchasers and consumers of health care have begun to demand accountability for the products they purchase. The initial focus of the system was "quality of care." When a number of research studies and reports highlighted the lack of basic safety in the American health care system, "safety" of health care was added to the discussion. It is the intent of this article to argue that quality of care is at this point in time not measurable, but that "appropriateness" of care is and can be measured based upon knowledge-based guidelines. With the option to use knowledge-based guidelines as sources for appropriateness indicators, the opportunity to add meaning to indicators and their meaning to the many stakeholders interested in this area cannot be ignored.