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them truly to know how they are doing. I believe that the natural instincts of the American marketplace will push these institutions to improve the outcomes for their patients with fractured hips, pneumonia, myocardial infarctions, and other medical and surgical conditions. They will do this only when they feel that these outcomes are an accurate reflection of the care that they arrange or provide. Internal steps designed to improve quality of care can and have worked extremely well when providers understand the importance of these maneuvers to improve the outcome for their patients.


Most of us chose the health care professions as our career because of a strong ego. We want patients to come to us and to our institutions because they believe that we will provide the best care available. If we believe that the outcomes reported to us are a true reflection of the results of care given to our patients, we will do all in our power to make those results as positive as possible. We will make these efforts only if we believe in the value and integrity of those reviewing us and in the results they generate. This entire process will have positive outcomes only if professionals buy into it as a cooperative venture, producing results with which all can agree.


In the final analysis, we believe that excellent medical care results from highly motivated, skilled, and energetic clinicians who feel that the system in which they work is responsive to the needs of their patients. Individuals will be encouraged to provide the highest standard of care if they see that these efforts result in improved outcomes for their patients. Furthermore, health care professionals have demonstrated the ability and desire to adjust their practice patterns when data point out the most effective patterns. We believe that the American health care system will achieve better results for its elderly patients if it encourages, stimulates, and rewards the motivation for caring that led many of us to enter the health care professions.


Institute of Medicine. Medicare: A Strategy for Quality Assurance. Volumes I and II. Lohr, K.N., ed. Washington, D.C.: National Academy Press, 1990.

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