Assuring Quality Out-Patient Care for Children

Dr Cook and Ms Heidt have written a book that synthesizes ten years of effort directed toward improving the quality and containing the cost of health care for children. This documentation of their work is thoughtful and painstaking. The book begins with three brief chapters, giving an overview of the problem. The first details the intimidating magnitude of their quest. The second and third chapters document problems in health care provision and review briefly past experience with efforts at quality assurance. Can two different health care facilities differ threefold to tenfold in their rates of performance of diagnostic tests or therapeutic endeavors and each still represent quality care at reasonable cost?

The remaining 85% of the book is devoted to a detailed description of the Pediatric Guidelines Medical Information System (PGMIS) now in place at six New York City municipal hospitals and one voluntary hospital. As the authors note, quality