This report describes a method designed to assess the quality of ambulatory health care in the Indian Health Service. This evaluation approaches the issue of quality assurance for ambulatory care through three basic performance criteria: 1) the method must be easily and economically incorporated into the existing system; 2) the method must identify areas of deficiency in health care and suggest adaptive programs to correct deficiencies; and 3) the method must view health care from the community perspective and examine the quality of the care actually received.This study design was developed around six methodological design questions: 1) what mode of health care delivery is assessed; 2) what aspect of quality is measured; 3) what is the content of the evaluation; 4) how is quality assessed; 5) from what perspective are the measurements taken; and 6) how are the results analyzed? The results of the above design decisions are then used to develop criteria-based indicators and instruments. The project product is a set of flow charts or process maps and tables which outline in detail, the performance and process criteria, and forms to be used to connect data and index the progress and effectiveness of actual patient status and health care performance. The final stage in the process is to propose a design for field testing the established methodology. The evaluation instrument was successfully completed, and implemented at the field test study sites.For the purpose of improving the pilot study and subsequent evaluations, the designers of this methodology strongly suggest that: 1) audit specific data should include all usual patient status data, complete patient history data, including negative as well as positive progress, and educational counseling plans and outcomes; 2) validity of proposed criteria ought to be supported by controlled clinical studies; and 3) only those elements of care which can actually be changed should be subjected to compliance with performance criteria.
Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-11).
Nutting PA. Shott GI. Berg LE. Studies in ambulatory care quality assessment in the Indian Health Service. Volume I: Overview of the methodology. Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-11). 1977