Assessing Quality of Ambulatory Care A Comparative Analysis in Rural versus Tertiary General Medical Clinics

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Abstract
The purpose of this study is to report the results and feasibility of a "multi-methods" assessment of ambulatory health care in both rural and tertiary care settings. Our method used an expert panel's assess ment of patient health and satisfaction outcomes (measured by follow-up telephone interviews) and care processes (measured by chart review) for assess ing complete episodes of care. Subjects consisted of a matched cohort of ambulatory adult patients from the above two settings. We identified and analyzed spe cific clinical errors to confirm the expert panel's judg ment of inadequacy. Results indicate that in both settings unacceptable health outcomes were found, at least partially explained by serious care deficiencies for 1 out of 2 to 3 patients seen. The problems, which involved mostly laboratory and pharmaceutic man agement, are probably preventable using newer edu cation and computer technologies. Our method, though dependent on adequate medical records, proved feasible in both the rural and tertiary ambu latory care settings studied.

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