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Medical Care Evaluations (MCEs) are in widespread use in hospitals in the United States as a means of evaluating and improving the quality of patient care. Increasingly, MCEs are required or used in ambulatory care facilities, particularly group practices. Mandatory quality assurance programs require internal review subject to monitoring by external reviewers. For internal self-evaluation, multiple simple task-oriented evaluations prove more feasible than the complex multifaceted all-in-one evaluations often used by external reviewers. A detailed review of methods for designing such focused, internally conducted evaluations of medical care is presented, covering the following issues: identification of problems for evaluation; use of process versus outcome data; choice of data source, topics and criteria; indices for case identification; units of care to be studied; and feedback interventions.

When the Massachusetts General Hospital and the Brigham and Women's Hospital announced their plans to merge in 1994, the idea of two prestigious academic centers joining together was novel. Now, almost three years later the merged entity, Partners Health Care System, Inc., has become a model for many academic health centers seeking strength in a time of fiscal uncertainty. Richard Nesson, MD, began his relationship with Harvard in 1954 as an undergraduate and now as president of Partners he has the task of directing Harvard's two largest hospitals. Through solid strategic planning and financial management, Nesson has been able to effectively position Partners to respond to increasing managed care pressures. Interviewed at Partners' headquarters in the Prudential Building in downtown Boston, Nesson discussed the growing penetration of managed care in New England and the challenges of maintaining the multiple missions of academic medical centers in an increasingly financially-oriented market.