Medical Audit JCAH-Style: A Positive View

To the Editor. — If Dr Rosenberg's assault on outcome audit had not been accompanied by a full page of misinformation, one would have no difficulty agreeing with his central line of argument, ie, good audit must contain both process and outcome elements. However, his statement that outcome audit is based largely on length of stay criteria, and that the PEP-JCAH system is therefore inadequate, is not correct. He confuses the central issue with the argument that somehow discussion of process items is more "inherently interesting" than is discussion of outcome elements. His statement that a PEP-style medical audit cannot be a useful instrument of continuing medical education has no more basis in fact than his statement about length of stay as the sole indicator of good care in the PEP system. Although I agree that good audits must be based on both process and outcome elements, his other statements