(1) Assumptions. When process is used as an indicator of quality, it is
assumed that particular elements and aspect of care are known to be specifically related to
successful or unsuccessful outcomes or end results (health status).
(2) Elements of process approach. In this approach, standards of care,
medical record review, and direct observation of performance are used.
c. Outcome. The outcome approach to assessment examines the health status
achieved for patients as a result of medical intervention.
(1) Assumptions. When outcome is used as an indicator of quality of care, it is
The practitioner's intervention was closely related to the change in
(b) Health status "can be" the ultimate criterion by which structural and
process measures of quality can be adjudged.
(2) Relationship to process approach.
The outcome approach validates the process.
(b) In cases of substandard outcome, calls for investigation of process to
define the reason(s) for the poor outcome.
d. Appraising P rocess and Outcome Approaches.In this approach to health
care assessment, process and outcome are evaluated through:
(1) Patient care assessment studies and occurrence screening. Patient care
assessment studies and occurrence screening employ techniques which involve the review
of patient care through documentation in medical records. Often, it is based on established
(a) This assessment of process is through traditional medical audit
procedures or other acceptable/applicable medical care evaluation/medical
Steps in the traditional audit are:
1 Selection of topic.
2 Establishment of criteria.