In the United States, activities related to assessment of the quality of care have completed a cycle, first concerned with end-results or outcomes, then structural attributes (qualifications of institutions and providers), and processes of care. Over a half-century later, the importance of assessing outcomes of care is being re-examined. A review of existing approaches suggests that the results of surveillance are dependent upon the methods used. Process criteria should reflect the decision-making activities of providers, not a consensus of ignorance. Those outcomes of care that are dependent upon patients behaviors (change in habits, use of medication, etc) should be studied as a function of the types of provider-consumer interactions employed. Perhaps only individual consumer involvement/control in the processes of care will result in improved outcomes.