Four evaluations of ambulatory pediatric tasks were used for quality assurance in eight pediatric group practices situated in two teaching hospitals and six related health centers. The evaluations used criteria incorporating branching logic to judge the quality of care revealed in data abstracted from medical records. Performance was evaluated for follow-up of positive urine cultures, assessment and follow-up of otitis media, initial assessment for gastroenteritis, and "well child" care for infants. A computerized data system was developed to process evaluation data and produce easily read reports. This work is part of a controlled trial of the feasibility, cost, and effectiveness of quality assurance as a means to improve patient care, but this preliminary report concerns only the principles for design of the evaluations and their use in quality assurance. Acceptance of evaluations by site providers was high: of 203 provider responses to a survey, only four reported disagreement with the criteria. Rates of cases "variant" from criteria and found on peer review to represent deficiencies in care, when averaged across sites, ranged by task from 1% to 47% of cases evaluated. In most sites, providers planned and implemented actions to correct these deficiencies. It is noted that improvements in care may increase costs of care.
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