Assessing the performance of medical care systems: a method and its application

As health care becomes more differentiated, fewer people receive the majority of their care from a single source. Yet, most methods for assessing health care focus on the care provided by a single facility or group of practitioners. A method is described which tracks individuals through the diffuse medical care "system" and examines the process of care received for complete episodes of care. Through the use of tracer conditions the individual's pathway through the system is followed and the contribution of the various system components (e.g., facilities and providers) is assessed for various functions of care (e.g., screening, diagnosis, treatment), thus pinpointing deficiencies in the process of care. The method is designed to sample systematically from the entire provider and consumer system. Use of this methodology in a variety of settings, including American Indian communities, has proved to be feasible and has uncovered deficiencies in the delivery of health services which might have been overlooked by other approaches. This article describes the assessment method and presents selected results which demonstrate the assessment outputs.