We hear much more about the quality of medical care than we ever have before. Measuring quality is fundamental to such policy proposals as pay for performance and investing consumers with the responsibility for shopping for health care (consumerism), about which you have read in the pages of this journal. Pretty much all of the conversation I hear devolves from the popular tripartite model of quality: structure, process, and outcome [1]. What's often lost in all of this is the questionable assumption that some care must be provided (ie, some care is always better than no care). Additionally, when some care truly is indicated, how do we determine what are the most appropriate measures for a patient?
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