Concerted action programme on quality assurance in hospitals 1990-1993 (COMAC/HSR/QA). Global results of the evaluation.

This article describes the global results of the evaluation of a concerted action programme on quality assurance in hospitals that was executed between 1990 and 1993 in a total of 262 hospitals in 15 European countries. The programme aimed to introduce quality assurance notions into European hospitals and focused on four specific topics; record keeping, prophylactic antibiotic use in surgery, preoperative assessment and the prevention of bedsores. Evaluation took place on a national level (descriptive country reports), hospital level (questionnaire) and topic level (questionnaire and results of QA studies performed in the participating hospitals). Different situational and operational factors on national, hospital and topic level, that seem to influence the effectiveness of strategies for the implementation of quality assurance, are identified. The relative importance of these factors is discussed and supported with empirical evidence. Part of the analysis is based on quantitative data based on comparing the situation in 113 hospitals in 1990 and 1993, before and after the intervention.