The Professional Standards Review Organization legislation enacted in 1972 (Public Law 92-603) had dual, interrelated objectives2: cost saving by reimbursing only for necessary services and hospital admissions, and assuring quality of care to patients by peer review. The first goal was to be achieved by utilization review, while medical care evaluation (MCE) studies were to satisfy the quality assurance component. In April 1979, the Joint Commission on Hospital Accreditation, while supporting the necessity for effective quality assurance programs, deemphasized the MCE component. The MCE studies are a type of medical audit and for the purposes of this discussion are used interchangeably with process-oriented medical audits. It is the purpose of this editorial to examine why MCE studies, which are commonly performed in accredited hospitals, have failed to substantially affect patient care.
The language of quality assurance breeds confusion, since the vocabulary is technical and the same terms are frequently