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Practice and Performance: An Assessment of Ambulatory Care

Joseph S. Gonnella, MD
JAMA. 1980;243(5):469. doi:10.1001/jama.1980.03300310057028.
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This book summarizes a study documenting the quality and patterns of care provided in a sample of ambulatory settings in Connecticut. The scope of the work and the quality of research are impressive. However, the reader should be aware of the limitations of the technique used to evaluate patient care.

For each of several medical problems, long checklists of steps taken in patient care and diagnosis were devised. Each item on the checklist was allotted a number of points, meant to reflect its importance to diagnosis and treatment. However, for a given problem, all criteria on the checklist for that problem applied to all patients, ie, branching was not used. Thus, the same exhaustive checklist would be applied to all patients with a given problem, eg, hypertension, when, in fact, patients' conditions might be more fairly evaluated if their records were audited for only those criteria that applied to their


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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