Assessing quality of care. The limitation imposed by Condorcet paradox

Condorcet paradox can be used to illustrate the mathematical impossibility of consistently ranking societal choices that are based on individual values. Quality-of-care measures reflect the values and interests of individuals (for example, physicians, patients, and payers) with differing perspectives of health care. Accordingly, appropriate decision making, technical performance, patient satisfaction, outcome, and cost-effectiveness are all valid examples of quality measures. Any attempt to prioritize or combine quality measures should be resisted if Condorcet paradox is to be avoided. The most consistent strategy is to strive to increase quality in each and every facet of its assessment.