This article summarizes available information on the efficiency and effectiveness of generic occurrence screening when used in quality assessment. Generic screening is relatively inefficient because of its multitiered review system and high rates of errors and false positives. Overall sensitivity may approach 70% to 80%, but specificity is estimated to range from about 22% to 73%. Effectiveness of generic screening in identifying problems in quality is limited by variability in peer review. Other limitations of generic screens include their lack of inherent relationship to the quality of patient care and their inability to provide direct performance measures for use in the periodic reappraisal of clinical privileges of medical staff members. We propose the monitoring of specific adverse surgical and medical clinical outcomes and related risk factors to increase efficiency in quality assessment and provide a more adequate database for the continual improvement of patient care and clinical performance.

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To test the feasibility and effects of incorporating concurrent quality assurance (CQA) into the concurrent utilization reviews required by PSRO's, adherence to essential criteria of medical care and attainment of expected immediate outcomes were monitored prospectively in 5604 cases of seven conditions in 24 experimental and 26 control hospitals in five PSRO areas. CQA was not consistently associated with improved documentation in records, but was associated with slightly better adherence to treatment criteria in all five PSRO areas (P less than 0.03). Adherence to pooled documentation or treatment criteria was unrelated to outcomes. However, failure to adhere to disease-specific scientifically validated treatment criteria was associated with unsatisfactory outcomes in bacterial pneumonia (P less than 0.01) and acute myocardial infarction (P less than 0.02). CQA was professionally acceptable, technically feasible and compatible with PSRO reviews. Given adequate physician support, CQA can produce slightly greater adherence to treatment criteria. If the criteria are valid, adherence may lead to improved immediate outcomes in some diseases.

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Below we print a symposium on medical audit and recertification. Dr. P. 7. Sanazaro, formerly of the United States Department of Health, Education, and Welfare, deals with experience in the US.A. which has led to official introduction of certain audit schemes. The remaining articles summarize five medical reactions to this and its implications for their own medical fields.