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Paul J. Sanazaro, MD; Don Harper Mills, MD, JD

JAMA. 1991;265(15):1977-1981.

Abstract
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.

(JAMA. 1991;265:1977-1981)

Author Affiliations
From the University of California School of Medicine, San Francisco (Dr Sanazaro); the Professional Risk Management Group, Long Beach, Calif (Dr Mills); and the University of Southern California School of Medicine, Los Angeles (Dr Mills).

Footnotes
Reprint requests to 48 Nor'east Dr, Harwich, MA 02645-2112 (Dr Sanazaro).

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