Quality assessment and monitoring. Retrospect and prospect.

A commentary on the papers in the two special issues on Quality Assurance which shows how they contribute to some important conceptual, methodological, and policy issues. These issues pertain to the definition of quality; the distinction between quality assessment and program evaluation; the role of the market in regulating the quality of care; the role of more direct consumer participation in defining and assessing quality; professional responsibility for quality; the applicability of the structure-process-outcome paradigm to quality assessment; the format, methods of formulation, and validity of the criteria; probability sampling and purposive selection of the topics to be assessed; problems of scaling and measurement; the applicability of industrial control methods to quality monitoring; bringing about behavior change in response to the findings of quality monitoring; measuring the costs and benefits of quality assessment methods, including a consideration of their screening efficiency; and the relationship between quality monitoring and cost containment through competition or by other means.