Quality assurance activity seems to have had little documented impact in terms of improving patient health or reducing care costs. One reason may be the lack of a practical and effective decision process for selecting priority areas where improvement of health or any other target outcome will most likely be achieved. This article describes a structured procedure for meeting this need. In addition, results of 14 years of quality assurance experience with structured and nonstructured topic selection procedures in 23 multispecialty group clinics and their associated hospitals are briefly reviewed. On the basis of this experience it is suggested that this priority method is both feasible and practical and can be recommended for application to most quality assurance systems. It is especially suited for planning medical care evaluation studies of the Professional Standards Review Organizations or the performance evaluation projects of the Joint Commission on the Accreditation of Hospitals.