A randomized controlled trial of quality assurance in sixteen ambulatory care practices

R. Heather Palmer, Thomas A. Louis, Lee Nah Hsu, Harriet F. Peterson, Janet K. Rothrock, Rose Strain, Mark S. Thompson, Elizabeth A. Wright

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


A crossover randomized controlled trial of cycles of quality assurance in 16 primary care (8 medical, 8 pediatric) group practices was conducted. Of four medical and four pediatric tasks important to patient outcome, two were randomly assigned to experimental intervention (a quality assurance cycle), and two were also measured and used as blinded controls for each medical or pediatric group practice. Task performance was measured in each group for 12 months prior to, 9 months during, and 9 months after the experimental intervention, using as a performance score the percentage of evaluation criteria failed of those applicable to a case. As a result of quality assurance intervention, quality of performance was significantly improved in two of the tasks (P < 0.0001, with 6.7, and 9.8 percentage points improvement), and marginally improved in one task (P = 0.06, 5.7 percentage points improvement). Surprisingly, tasks with lower perceived effect on patient health (low physician motivation) had greater improvement in quality. Unimproved tasks were associated with the perceived need for delivery system changes beyond the immediate control of the individual practitioner.

Original languageEnglish (US)
Pages (from-to)751-770
Number of pages20
JournalMedical care
Issue number6
StatePublished - Jun 1985
Externally publishedYes


  • Ambulatory care
  • Medical care evaluation
  • Multisite evaluation
  • Quality of care
  • Randomized controlled trial

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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