BOOKS OF RtfiDIfGS - PAHO/WHO

MEDICAL CARE
,arch 1981, Vol. XIX, No. 3
- 121 -
Assessing the Performance of Medical Care Systems:
A Method and Its Application
PAUL A. NUTING, M.D.,* GREGORY 1. SHORR, M.D.,t
AND BARTON R. BURKHALTER, PH.D.S
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 pathwAay through the
system is followed and the contribution of the various system components (e.g.,
facilities and providers) is assessed for various funetions of care (e.g.. sereening,
diagnosis, treatmnent), 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 demrnstrate the assessment outputs.
AS TECHNOLOGY and specialization increase,
consumers of health services are
faced with a bewildering array of different
individual and institutional provide -
with ever fewer receiving their care frorm a
single source. Solutions to the problem are
' Associate Director for Research, Office of Research
and Development, Indian Health Service,
Deparbntment of Health and Human Ss. ices.
f Director, San Xavier Ambulatory Care Project, Office
of Research and Development, Indian Health
Service.
t Senior Scientist,' Community Systems Foundation
and Professor (Adjunct), Departnent of Family
and Community Medicine, University of Arizona.
All opinions expressed herein are the authors' and
do not necessarily represent the policy of either the
Indian Health Service or the Department of Health
and t!uman Services.
Address for reprints: Paul A. Nutting, M.D., Associate
Director for Research, Office of Rescarclh and
Development, Indian Health Service, P.O. Box
11340, Tuicson. AZ 85734.
0025-70791811030010281/$01.30 O J. B. Lippincott Co.
offered from at least tv'o philosophical
viewpoints. Some argue that tect, logy
and specialization should be decrit ed
and the goals of the health care system
- 'ised to give more control to consumers
an . -- attention to the environment and
style: c 'iving,'-5 while others find
evidence i the high degree of specialization
shou!-' be maintained and better
management auc ed to it. 6
Methods of qua;'' -- 'essment and assurance
may eventually contribute to better
management of health care rystems.
However, quality assessment and assurance
have yet to demonstrate their worth.
Most assessments ofthe quality of care address
only narrow segments of the complex
array of services. Some focus only on the
care provided by single facilities or groups
of providers. Others focus only on care
proviaed to those patients who have