Evolving emergency care standards for asthmatics

The paper suggests a methodology for assessing the process of health care and presents different methods of improving reliability, validity and summarization measures reflecting overall quality of care rendered. The study focused on development of standards for the management of asthma by a sample of 28 clinicians at Johns Hopkins Medical Institutions. Sample assessed 67 'candidate' standards on a seven point scale denoting absolutely necessary/excellent practice vs. completely unnecessary/poor practice. Thirty-four standards were accepted as clinically significant by the panel and applied to chart reviews of a consecutive series of 357 asthma patient visits during July and August 1975. Compliance rates for each of the standards were calculated. Several different methods of summarization were then presented that involved differential vs. non-differential weighting of standards to reflect clinical significance, summary scores for history and physical examination items received by the asthma patient and summary scores that penalized for non-compliance. It is concluded that the results indicate substantial aspects of this methodology seem to be feasible and useful, but further testing with standards and expert validating groups that differentiate more widely as to clinical significance is needed.