Quality of Care

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Abstract
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

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