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Quality-of-Care Appraisal in Primary Care: A Quantitative Method

JOHN C. SIBLEY, M.D., F.R.C.P., F.R.C.P.(C), F.A.C.P.; WALTER O. SPITZER, M.D., M.H.A., M.P.H.; K. VINCENT RUDNICK, M.D., C.M.; J. DOUGLAS BELL, M.D.; RICHARD D. BETHUNE, M.D.; DAVID L. SACKETT, M.D.; and KAREM WRIGHT, R.N., B.N.
[+] Article and Author Information

Grant support: in part by National Health Grant 606-21-66 of Health and Welfare Canada.

▸Requests for reprints should be addressed to J. C. Sibley, M.D., Room 2E18, Health Sciences Centre, McMaster University, Hamilton, Ontario L8S 4J9, Canada.


Hamilton, Ontario, Canada


Ann Intern Med. 1975;83(1):46-52. doi:10.7326/0003-4819-83-1-46
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A reproduceable method has been developed for measuring the quality of clinical care provided by physicians and nurse practitioners. The distinctive features of the method are the extended use of the tracer disease concepts, the evaluation of referrals, new procedures for probing the clinical operation of practices, a single blind design, emphasis on the use of the untouched medical record, the ability to compare results with measurements of concurrent outcome, and a relatively low cost. Three simultaneous approaches used in the method are described: surveillance of the management of indicator conditions, evaluation of clinical use of drugs, and the assessment of referral decisions. The three approaches gave consistently similar results about the relative performances of the practices compared and were in agreement with concurrent outcome studies. The method was successfully implemented in a health care experiment.

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