ready been adopted by DHHS as a conceptual framework for the National Health Care Quality Report. They have also been endorsed in whole or in part by various private-sector groups including the Leapfrog Group and NQF. In addition, another IOM committee has identified a list of 20 priority areas for health system improvement, and these represent excellent candidates for the development of standardized performance measures (Institute of Medicine, 2002). Most of the government programs have identified leading chronic conditions and health concerns for their populations, and there is much overlap in all of these lists.


Government health care programs reflect a growing recognition that measuring quality and using quality performance measures to improve health care is central to the federal government’s roles of regulator, purchaser, and provider of health care for almost half the U.S. population. Yet too many resources are spent on health care measures that are either duplicative or ineffective, and little comparative quality information is made available in the public domain for use by beneficiaries, health professionals, or other stakeholders. Furthermore, potential users of the available measures are often hindered by the lack of reporting standards, conflicting methodologies, and inconsistent terminology (Eddy, 1998; Rhew et al., 2001). Standardizing measures can lessen the confusion. In addition to addressing these problems, the committee believes standardized performance measures could drive quality improvement in numerous other ways:

  • By drawing attention to best practices and encouraging providers to adopt them.

  • By facilitating comparisons of accountable entities, such as hospitals, health plans, long-term care facilities, and, potentially, physicians’ practices.

  • By enabling the development of national benchmarks and helping to identify regional differences.

  • By supporting efforts to sensibly reward quality through either payment or other means.

  • By expanding the research community’s capacity to identify the factors that drive or diminish health care quality.

  • By helping to make the link between accountable entities and patient outcomes.

  • By providing the clinical data needed to formulate workable risk adjustment techniques.

  • By providing the necessary data to identify providers who demon-

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