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Time to Act

Mark R. Chassin, MD, MPP, MPH

JAMA. 1991;266(24):3472-3473.

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

Many physicians think about quality of care the way Justice Stewart characterized his ability to recognize pornography:

I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [hardcore pornography]; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it....¹

A growing armamentarium of new quality assessment tools renders this proposition dangerously obsolete. Their application has resulted in a growing body of literature that documents significant quality problems in American medicine.

Quality problems come in three varieties: overuse, underuse, and misuse. Overuse is the provision of health services when their risks outweigh their benefits; underuse is the failure to provide health services when their benefits exceed their risks; and misuse occurs when an appropriate health service has been selected but is then poorly provided, so . . . [Full Text PDF of this Article]

Author Affiliations
From Value Health Sciences, Santa Monica, Calif. Value Health Sciences is a for-profit company that markets tools for assessing the appropriateness of health services.

Footnotes
Reprint requests to Value Health Sciences, 2400 Broadway, Suite 100, Santa Monica, CA 90404 (Dr Chassin).

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