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Computerized decision support and the quality of care.

The notion of quality of care in medicine is not new, but it is becoming increasingly important as the competitive health care market demands objective measures to compare physicians, hospitals, and managed care organizations. Informatics researchers and health care vendors have responded with computer systems that promise to improve health care delivery. How well do these systems fulfill the promise? The answer requires an understanding of systems and the standards of quality used to assess them. This review paper will focus on the computerized methods designed to improve some components of quality of health care. The first section will provide a broad definition for quality of care and discuss the ways it is measured. The second portion of this article is a hypothetical case discussion of the implementation of strategies of quality improvement. We provide expectations of the effectiveness of these strategies with different degrees of computerized support. Finally, we review the literature in computer-based decision-support systems, and draw conclusions about their effects on aspects of quality.