Certain Concepts Useful in Designing Problem Oriented Assessments of the Quality of Medical Care: Applications to Diagnostic Processes

摘要

This thesis presents certain concepts useful in organizing a problem oriented assessment methodology. These concepts are organized into an overall framework. The framework is used to analyze methods for the investigation of problems in medical diagnostic processes. Methods are identified for research designed to provide the information needed to address the two essential general questions in problem-oriented assessments and the one additional concern needed to make operational the answers to these questions. The first general question is 'Which care process events should be considered problems.' The second general question is 'What are the incidence rates of such problems in specific care settings.' The ancillary concern is to describe the problems found to have occurred, their causation, and of the pathways through which they cause undesirable changes in the end result of the care processes with the accuracy and detail needed to guide the choice of corrective actions likely to be effective in reducing the costliness - the probability or the magnitude - of those undesirable changes. Recent events have made clear the need for this work.