I n the current medical-care era of accountability, it is argued that formal programs for quality assessment be developed in academic centers. The issues addressed include: (1) medicine's increasing use of the latest technology matched by the public's sense of entitlement for optimal care; (2) the increasing perception by both physicians and patients of a need for 100% certainty; and (3) the utility of applying epidemiologic methods to complex health care issues.
The timing is propitious to forge a closer bond between the clinical staff and the hospital administrators to meet the common goal of differentiating those practices that are effective from those that merely consume resources.
The concern for high quality medical care in the United States is palpable. In large part this has been stimulated by the widespread recognition of the continued inflationary costs of modern medicine and corresponding questions about relative benefit. In 1989, $600 billion was