In 1966, Avedis Donabedian published a seminal article showing the importance of measuring health care quality. Donabedian also defined that it should be done in the dimensions of structure, process or results. The author showed that the “results” dimension is not necessarily related to the other two. While the measurement of some results, such as mortality, is easy to be carried out, other results are difficult to be measured, such as quality of life and patients’ satisfaction.

In the early 80’s, I became interested in the subject of health care quality. My thesis to obtain the master’s degree in Internal Medicine from the Federal University of Rio de Janeiro Medical School was entitled “Hypertension: health care quality at the HU-UFRJ”.

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