The most important development in quality assurance in the past few years has been a shift in focus from processes of care to outcomes of care. A growing role for governments and large purchasers and an increasing use of large data sets has accompanied this change of focus.
At least three states (Pennsylvania, Iowa, and Colorado) now have a state commission that must collect data on the quality of care in the state's hospitals. All three commissions have chosen an approach based on collecting clinical data that will allow comparison of risk-adjusted outcomes among hospitals. Other states, including Maryland, Ohio, New Hampshire, Washington, and Maine, are engaged in state-level voluntary or official activities aimed at comparing hospital performance, physician activities in small areas, or outcomes of various kinds of care.
Third parties are intensely and aggressively interested in the quality and appropriateness of care. Business coalitions are largely responsible for