RESUMEN
This study was undertaken to compare process and outcome methods of quality assessment of medical care in outpatient office practice. Follow-up care after hospitalization for first acute myocardial infarction was used as the model. One hundred fifty-two patients followed up for a minimum of 2 years comprised the study group. An expert committee of cardiologists and internists in community practice established the process criteria for satisfactory care and predicted outcomes of continuing disability and mortality. Using weighted process criteria and a weighted performance index permitted demonstration of a significant association between process items performed at the first posthospitalization visit and 2-year mortality. A significant association could not be demonstrated between later process of care and outcome at 2 years. The outcome assessment study disclosed that predicted disability and mortality rates compared closely with observed outcomes. However, this method for evaluating the quality of outpatient medical care is weakened because little information is available to provide the basis of prediction of satisfactory outcome rates in complicated cases. Although both the process and outcome methods of quality assessment have short comings, the latter method is recommended because satisfactory outcomes is the essential criterion of quality medical care. Moreover, when process items are not specified outcome assessment maintains the flexibility of individual physician practice. Refinement of satisfactory outcome prediction for common illnesses managed in office practice should be the goal for future studies.
Asunto(s)
Cuidados Posteriores/normas , Infarto del Miocardio/terapia , Calidad de la Atención de Salud , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , MinnesotaAsunto(s)
Cardiomiopatías/patología , Sistema de Conducción Cardíaco/patología , Distrofia Miotónica/patología , Fascículo Atrioventricular/patología , Cardiomiopatías/fisiopatología , Electrocardiografía , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Distrofia Miotónica/fisiopatología , Nodo Sinoatrial/patologíaRESUMEN
In two pairs of monozygotic twins with coronary artery disease who were studied by coronary angiography, there were striking similarities in the clinical course, response to exercise, and distribution of coronary artery disease. Though it is difficult to distinguish between heredity as an independent risk factor and the other major risk factors, the similarities in each twin pair may be best explained by identical heredity.