QUALITY ASSURANCE AND ACCOUNTABILITY
Section I. GENERAL
QUALITY ASSURANCE EVOLUTION AND HISTORICAL EVENTS
a. Historical Perspective. Despite our limited ability to define quality medical
care or to assess it accurately, political, social, legal, and economic pressures have
stimulated a growing interest in its assurance. Prior to the 1900s, physicians provided
care individually with little reliance on hospitals for support and assistance. They were
responsible only to themselves for their actions. After 1900, physicians began to use
hospitals more but maintained the doctor-patient relationship unchallenged. Quality
assessment means measuring the level of quality of care provided at some point in time,
but suggest no effort to change or improve that level of care. Quality assurance includes
the measurement of the level of care provided and the attempt to improve it. The current
interest in quality assessment and quality assurance in the United States is due to several
(1) the rising costs of medical care.
(2) increased government funding.
(3) increased consumer expectations and concurrent rise in malpractice
(4) rapid advances in medical technology.
(5) demonstrated poor level of quality.
b. The Flexner Report. In 1910, a report by Dr. Abraham Flexner disclosed the
poor quality of medical education in the United States and stimulated the elimination of
"diploma mills." By 1920, the Flexner Report was instrumental in closing 60 of the 155
medical schools in the United States. It was also influential in effecting more stringent
admission requirements and changes in curriculum, and aided the medical education of
minorities who previously had not been admitted to medical schools.
c. The Codman Study. In 1916, Dr. E.A. Codman, a pioneer in quality
assessment, studied the end results of medical care. This famous study emphasized the
same issues being discussed today in regard to quality of care:
(1) the importance of licensure or certification of health care providers.
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