A review of methods for ambulatory medical care evaluations

Medical Care Evaluations (MCEs) are in widespread use in hospitals in the United States as a means of evaluating and improving the quality of patient care. Increasingly, MCEs are required or used in ambulatory care facilities, particularly group practices. Mandatory quality assurance programs require internal review subject to monitoring by external reviewers. For internal self-evaluation, multiple simple task-oriented evaluations prove more feasible than the complex multifaceted all-in-one evaluations often used by external reviewers. A detailed review of methods for designing such focused, internally conducted evaluations of medical care is presented, covering the following issues: identification of problems for evaluation; use of process versus outcome data; choice of data source, topics and criteria; indices for case identification; units of care to be studied; and feedback interventions.