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organizations, especially in the MQROs1. The second consists of investigators who will carry out the research. The investigators themselves fall into two main groups: those who would work to strengthen the weak knowledge base of the methods and the impact of quality assurance, and those who do the research that will provide data on effectiveness and outcomes of various interventions or alternatives that constitute the information base for much of the quality assurance process.

Regarding the operation of the program, the report appropriately emphasizes the fundamental importance of a core of professionals prepared to provide both technical skills and leadership. There seems to be general agreement in the committee that at present we lack an adequate number of professionals to staff a nationwide program and that establishing training programs to prepare these professionals should be a high-priority item. The committee apparently envisioned that these educational programs would require a year of study—I see the period of training as very variable—and that such programs could be built on existing programs in epidemiology, health care research, and biostatistics. Re-education of existing staffs and senior professionals already working in the area will facilitate implementation of the program until organized training programs that would include field experience could be developed to prepare this new cadre of health workers with the tools needed to collect and apply information for quality assurance.


The professional staff required for the program will require a diverse group of individuals with many different skills, including persons trained for leadership roles, as managers, in data acquisition and analysis, evaluation, record abstraction, information science, questionnaire development, ethics, and so forth. Much work remains to be done in identifying the types and numbers of such persons who will be needed to establish a nationwide network for quality assurance.

Because of the diversity of the group, it seems inevitable that the type and duration of training will vary greatly. Curriculum development for the types of personnel that will be required is a high priority. Some experimentation through demonstration projects might be advisable to define the optimum staff for the MQROs and other components of the system. I very much like


Editors' Note: The reference is to Medicare Quality Review Organizations (MQROs), ''local'' organizations proposed by the IOM committee as part of its Medicare Program to Assure Quality (IOM, 1990).

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