Quality of care: past achievements and future challenges

The heightened attention currently given to quality of care offers a unique opportunity for major advances. But to make the most of it, the greater energy and resources now available have to build on what is already known about quality of care, rather than largely ignore and therefore rediscover what has been learned in the past about, for example: how quality can be defined and measured, the relation between outcomes and the process of care, and the distinction between quality assessment and determinations of efficacy. If future efforts are rooted in what is known about these and other aspects of quality of care, they can yield substantial insights into how to improve quality, rather than simply how to measure it, and how to do it for more than inpatient hospital care.