Criteria of Process and Outcome

To the Editor: The article by Nobrega et al. on “Quality Assessment in Hypertension: Analysis of process and outcome methods” (N Engl J Med 296:145, 1977) and the accompanying editorial by Brook (296:170, 1977) make the point that no relation exists between long laundry lists of process criteria and patient outcomes. I hope the importance of this message is not lost to those undertaking medical audits. I fear, however, that many readers may carry that point beyond what the authors actually say — namely, that there is no relation between process and outcome. If this hypothesis were true there.