The challenges and prospects for quality assessment and assurance in ambulatory care.

As hospital cost containment has moved care into ambulatory settings, quality assurance requirements have followed. These requirements should focus on primary care as a means to prevent disease and limit disability while saving hospital costs. Methods for external and internal quality assurance already exist for primary care, although refinement and development of less expensive techniques is needed. Uniform quality assurance requirements that satisfy all external reviewers should be developed and applied evenhandedly to fee-for-service and prepaid providers. A top priority is the development of a uniform computerized data base for primary care encounters.