Attempts to improve quality by organizations were viewed as veiled attempts at cost containment rather than improvement of care. However, our ability to monitor quality has dramatically improved over the last decade, bringing established scientific methodology to the field of quality assessment. Evaluations of structure look at characteristics of physicians and hospitals, such as how nice the waiting room is or what medications are included in a formulary. These domains can have a substantial effect on customer satisfaction, and can affect the process of care by limiting access to beneficial treatments. Treatment process is important because it can be changed, and because it affects outcomes.
Outcomes are inherently important.
However, poor outcomes have many causes, and, in fact, medical care only has a small effect on outcomes. Other factors, such as genetics, severity of illness, sanitation, and smoking have stronger effects on outcomes. Panels of experts generally conduct this review and then use this information to develop treatment standards that can be used by clinicians. While studying patients' charts, Dr. Young found that medical records often failed to report on the presence of severe symptoms or medication side effects, indicating that using medical records alone is not sufficient for measuring appropriateness of care. Patient interview can also provide incomplete or inaccurate information because of the impact this illness has on the patients' ability to communicate.