This article clarifies concepts and theories used in quality assurance and their applications and
offers a time-ordered conceptual framework for quality assurance standards and indicators,
emphasizing the necessity for balance among them. Processes of monitoring and feedback are
discussed as major components of quality assurance systems. This time-ordered, systems
approach to quality assurance was applied to home care services in Ohio. This theoretical
perspective is related to current public policy aimed at nursing home reform.
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