Quality assurance: an overview and outline for gastrointestinal endoscopy

Insuring the quality of medical care in the prevailing climate of cost containment is a concern shared by providers of health care and patients alike. For most practicing physicians, however, little has been included in their medical training to introduce them to the health care discipline of quality assurance. In the following review of that topic, medical care is conceptually divided into the elements of structure, process, and outcome, as originally proposed by Donabedian. The use of measurement to identify possible problems within these three areas of medical care is then explored. Finally, a variety of quality assurance projects, all pertaining to gastrointestinal endoscopy, serve to illustrate the principles discussed.