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Internal Elegance and External Relevance

Barbara Starfield, MD, MPH

JAMA. 1998;280:1006-1008.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Much of quality assessment is based on approaches that have been around for the better part of the 20th century. Even the focus on outcomes dates back more than 80 years to the exhortations of Ernest Codman.¹ The inclusion of patient opinion is not new either; consumerism dates back almost half a century and the literature on consumer attitudes and satisfaction has a long history.² The President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry spent more than a year discussing the challenges. Its report made more than 50 recommendations to "advance the purposes of continuously reducing the impact and burden of illness, injury, and disability and to improve the health and functioning of the people of the United States."³ These recommendations focused primarily on using the results of research to improve patient care, as well as building an "ongoing research agenda . . . [Full Text of this Article]

Relevance of Research Questions

Importance of Patients' Problems

Inappropriate Prescribing

Generalizability of Research Findings

Ecological Characteristics

Role of Health Care Services Organization

Consumer Experiences

Need for Better Information

From the Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.

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