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Milbank Q. 1989;67(2):233-56; discussion 257-67.

The end results of health care: Ernest Codman's contribution to quality assessment and beyond.

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Department of Health Services Management & Policy, School of Public Health, University of Michigan, Ann Arbor 48109.


E.A. Codman's conception and development of the "end result idea" in the 1910s are unduly neglected in the history of health care assessment. The "idea" entailed following patients long enough to determine if treatments proved successful and taking comprehensive measures to prevent new failures if outcomes were undesirable. Codman's work anticipated contemporary approaches to quality monitoring and assurance, establishing accountability, and allocating and managing resources efficiently, among other assessment features. Complexity and ambiguity in health care objectives, decision making, and role responsibilities as well as costs today hinder full application of his vision, but refinement of these factors proceeds in the directions Codman set forth.

[Indexed for MEDLINE]

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