Case-based quality management system for surgery, a bottom up approach.

: Quality control has become a familiar concept in health care in The Netherlands in the last ten years, as it has elsewhere in the Western world. To achieve the goals of total quality, medical audit plays a central role in the process. An important issue for medical audit is to collect consistent and coherent data on the medical performance. As no widespread tradition exists to do this routinely using common widely accepted protocols and information technology, examples of routine quality control of medical services are scarce. In this paper a report is given of the process of collecting routine data on the surgical treatments and its complications in a Dutch general hospital. Based on the results of this and other local initiatives to control and improve the quality of surgical procedures the Dutch Association of Surgeons has recently adopted a policy document, which promotes to enhance quality Management. This paper presents also the increasing need among health care professionals to compare the results of treatment of similar patients. The role of Information Technology to achieve these goals is growing at an impressive pace. A more complete documentation of the care process will increasingly support a case based approach, which will be essential for a comprehensive analysis and Management of the care provided to patients. The paper supports a systematic collection of data documenting structure, process and outcome.