Directly Observed Care: Crossing the Chasm of Quality Measurement

J Gen Intern Med. 2023 Jan;38(1):203-207. doi: 10.1007/s11606-022-07781-1. Epub 2022 Sep 20.


After more than two decades of national attention to quality improvement in US healthcare, significant gaps in quality remain. A fundamental problem is that current approaches to measure quality are indirect and therefore imprecise, focusing on clinical documentation of care rather than the actual delivery of care. The National Academy of Medicine (NAM) has identified six domains of quality that are essential to address to improve quality: patient-centeredness, equity, timeliness, efficiency, effectiveness, and safety. In this perspective, we describe how directly observed care-a recorded audit of clinical care delivery-may address problems with current quality measurement, providing a more holistic assessment of healthcare delivery. We further show how directly observed care has the potential to improve each NAM domain of quality.

Keywords: directly observed care; healthcare quality; patient-centered care; unannounced standardized patients.

Publication types

  • Editorial

MeSH terms

  • Delivery of Health Care*
  • Humans
  • Quality Improvement*
  • Quality of Health Care