Assessing the quality of emergency care: the medical record versus patient outcome.

The relationship between the quality of medical records and patients' health status outcomes remains unclear. For a group of patients treated and discharged with diagnoses of acute bronchial asthma, we asked: Is the quality of medical records directly and positively related to the quality of patients' health status outcomes once factors not completely within physicians' control are taken into account? Record quality was assessed by comparing information recorded with a set of criteria considered to constitute effective care. Data reflecting health status were based on telephone interviews with patients one to three and 10 to 12 days following visits. Correlation and multiple regression analyses showed the quality of records to be negatively, although not significantly, related to patients' health statuses. The results of the analyses are used to assess the adequacy of quality assurance programs concerned only with the quality of medical records, and to evaluate the advantages and disadvantages of including assessments of patients' health statuses in regular quality assurance reviews. We conclude that quality assurance programs periodically should include reviews of patients' health status outcomes.