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To the Editor: Autopsies could have new and important roles in monitoring quality and improvement in addition to the roles enumerated in JAMA.^1-2 First, increasing proportions of Americans die outside of the hospital and most are old, multiply ill, and have had limited diagnostic interventions.³ Without autopsies, no one can know how often medical mistakes are buried.

Second, measures of function, symptoms, and costs in a health care system may appear to improve when practices are adopted that generally yield a slightly shorter life. Better rehabilitation or prevention services might appear to cause a healthier functional status in one population compared with another. This conclusion could be wrong if the time spent with severe disability was generally curtailed in the healthier population by earlier death.

Third, autopsies could be indicators of overall performance of care systems compared over time or among systems.⁴ Methods could be generated to sample deaths . . . [Full Text of this Article]