Quality of health care for women: a demonstration of the quality assessment tools system.
BACKGROUND
Consumers, purchasers, and regulators are seeking information on quality for a variety of purposes. To address these demands, methods are required that are flexible in meeting the information needs of different audiences.


OBJECTIVE
To test a new clinically detailed, comprehensive approach to quality measurement called Quality Assessment (QA) Tools.


METHODS
Quality measures were developed for women ages 18 to 50 years for preventive care and 17 clinical areas that included chronic and acute health problems. A stratified random sample of women enrolled in 1 of 2 health plans in 1996 to 1997 was drawn and data abstracted from the medical records of all their providers for a 2-year period.


RESULTS
We evaluated quality for 758 women in 2 managed care plans. Quality of care varied substantially depending on the dimension being examined. For example, acute care was significantly better than chronic or preventive care. Quality was highest for follow-up care and lowest for treatment in both plans. Quality by modality ranged from approximately 90% for referral or admission to 16% for education and counseling. We found significant differences between the plans in the quality of care for 7 of the 17 conditions studied.


CONCLUSIONS
The QA Tools system offers an alternative approach to evaluating health system performance. Potential advantages include the richness of the information produced by the system, the ability to create summary scores for consumers and purchasers, and the system-level performance information for use in quality improvement activities.
McGlynn
Elizabeth A
EA
RAND, Santa Monica, California 90401, USA. mcglynn@rand.org
Kerr
Eve A
EA
Adams
John
J
Keesey
Joan
J
Asch
Steven M
SM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006125:Group Practice, Prepaid / Q000592:standards; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D007193:Independent Practice Associations / Q000592:standards; D008329:Managed Care Programs / Q000145:classification / Q000592:standards*; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D014481:United States / Q000453:epidemiology; D014932:Women's Health Services / Q000592:standards*