Sorting through the quality assurance armamentarium.

M uch heailh services research and pmject development is focused on clefining appropriate, high quality care, and on developing instruments to Jllonitor quality of cal-e anu facilitate health care decisions Research is directed tuwal-u developing imlicatocs of care anu appmpriatcness criteria, and studying outcomes of cal-e and practitionersJlanerns of care Additionall~', projects are undenva~' to develop clinical guidelines and practice parameters, as weJl as clinical algorithms. Along with guidelines ami indicators, there are also longstanding standards of care, treatment protocols and policies, and medical criteria Such an armamentarium can be confUSing. How do these instruments uiffelfrom one another' How are they the same' The pUl-pose of this anicle is to describe parameters, guidelines. and indicators, and to provide an update on who is developing them. Qualily assurance instrumenls are beginning to play an important role in the provision of health care and to raise many important policy issues. It is pl-Udent fm occupational therapists ami other health care pl-ofessionals to develop a familiarit~' with them Most of these guides and monitOl-ing insu-uments ~lre nor really new Occupational therapists and orher health care professionals have sought to define standard ancl accepted practices of care and have developed various treatment protocols and criteria as their professiC)[lS evolved. In occupational therapy, treatment protocols and criteria were often used to gUide student fieldw()l-k, to conve\' to other health professionals what occupational thel-apists uo. and to provide a general standard or gUide b\' which occupation<ll thel-apists could plovicle tre<ltment. Thev were usually developed voluntarily, on an ad hoc basis, and the methodologv used to develop Ihem was inforJllal. Iy!ost often, these documents were developed )ocall\' \:vithin a department in a facility