Quality Assessment in Hypertension: Analysis of Process and Outcome Methods

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Abstract
Despite efforts to develop methods for measuring the quality of medical care, no satisfactory mechanism has been established. Our study, using hypertension as a clinical model, evaluated process and outcomes separately and then compared the two. Physician adherence to an extensive process list varied substantially from established criteria. No statistically significant association was detected between process and outcome. Regression analysis examined the relation between outcome diastolic pressure and 12 predictive variables that included patient satisfaction and social class. The only statistically significant variables (P<0.05) related to outcome blood pressure were age, initial blood pressure and weight. The inability to identify a relation between various process items and outcome suggests that, in determining a successful outcome for hypertensive patients, the selective use of process by the physician may be more effective than adherence to a rigid criteria list. (N Engl J Med 296:145–148, 1977)

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