Quality assurance in anatomic pathology. An information system approach.

Quality assurance (QA) is the outcome-oriented process by which the performance of a complex production operation is evaluated. It is strongly focused on the use of resources and the end product, and is closely related to marketing. The pathologist's product is information, and the practice of anatomic pathology is evaluated as a system for producing and effectively communicating information. Our integrated program for QA in surgical pathology, autopsy pathology, and cytopathology recognizes that several discrete elements make up the sequence leading to communication of the diagnostic opinion. These are control and processing of the specimen, accuracy of diagnosis, timely and clear communication, efficiency in production of information, coherence with institutional programs in QA, and relation to licensing and accreditation agencies. Each of these elements may be tested separately and sources of error reduced so that the validity and cost of the pathologist's prediction will ultimately be limited only by the state of the art and not by any failure of the information system. Several components of QA, especially resource utilization by pathologists, are potentially productive areas for operations research.