title: Assessing quality of ambulatory care. A comparative analysis in rural versus tertiary general medical clinics.
abstract: The purpose of this study is to report the results and feasibility of a "multi-methods" assessment of ambulatory health care in both rural and tertiary care settings. Our method used an expert panel's assessment of patient health and satisfaction outcomes (measured by follow-up telephone interviews) and care processes (measured by chart review) for assessing complete episodes of care. Subjects consisted of a matched cohort of ambulatory adult patients from the above two settings. We identified and analyzed specific clinical errors to confirm the expert panel's judgment of inadequacy. Results indicate that in both settings unacceptable health outcomes were found, at least partially explained by serious care deficiencies for 1 out of 2 to 3 patients seen. The problems, which involved mostly laboratory and pharmaceutic management, are probably preventable using newer education and computer technologies. Our method, though dependent on adequate medical records, proved feasible in both the rural and tertiary ambulatory care settings studied.
authors.affiliation: Salt Lake City Regional Medical Education Center, UT.
authors.forename: J W
authors.initials: JW
authors.lastname: Williamson
authors.forename: C S
authors.initials: CS
authors.lastname: Fehlauer
authors.forename: J
authors.initials: J
authors.lastname: Gaiennie
authors.forename: C B
authors.initials: CB
authors.lastname: Smith
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D003151:Community Health Centers / Q000592:standards*; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003625:Data Collection; D005069:Evaluation Studies as Topic; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D012107:Research Design; D012423:Rural Health / Q000706:statistics & numerical data; D014589:Utah