Strengths and limitations of quality assessment measures
| Process measure of quality | Strengths | Limitations | Assessment level |
| Unannounced standardised patient | Standardised, controlling for case-mix and patient- mix; Unannounced, no Hawthorne effect (if not be detected); Reduced recall bias | Expensive Limited medical conditions First-visit bias Selection bias if informed consent is required |
Action (Do) Gold standard |
| Clinical vignettes | Cost-effective; Suitable for large scale and cross-system comparison; Covering all illnesses; Accounting for case-mix and patient-mix. | Hawthorne effect Selection bias |
Competence (Know how) Overestimating care quality (best answers) or similar |
| Virtual patients | Interactive Real-time response and automatic record Highly standardised Scalability and low marginal cost Efficient delivery: anytime, anywhere Suitable for large scale study | Hawthorne effect Selection bias High cost in initial development |
Performance (Show how) ? |