“…The barriers encountered in evaluative health research are administrative, financial, consensual, methodological, and technical. Studies that assess the quality of care can be handicapped by (1) the lack of explicit, measurable, realistic, clinically sound criteria, as well as indicator quality and quantity; (2) the need to distinguish between client and provider factors and quality and cost; (3) the multiplicity of health workers and records; (4) the absence of written evaluation mechanisms; ( 5 ) inadequate provision for timely feedback of results, budget restrictions, and insufficient expertise in evaluation techniques, and (6) inadequate data, collected with instruments of questionable reliability and validity (ANA, 1976;Hegyvary and Haussmann, 1976;Morris, 1977;Highriter, 1977;Daubert, 1979;Flynn and Ray, 1979;Kelman, 1980;Martin, 1980;Spivak and Bonanno, 1980;Lavenhar et al, 1981;and Cradduck, 1986).…”