tial. Comparative data appropriately presented have the potential to assist consumers in provider and plan selection, thereby creating market incentives for providers to improve care as well as channeling patients to higher quality providers as reflected by the measures. Similarly, access by providers (including government operated delivery systems) to comparative information on quality may enable them to better assess their own clinical environment and identify accepted processes for improving care.
The provision of comparative performance data to patients may also provide the opportunity to educate patients about the critical elements of their care. While the effect of performance measures on patients’ medical self-management has not been evaluated, familiarity with the core measures could potentially enable consumers to better understand the critical elements of their care and become more active participants in their own health care management (Greenfield et al., 1985). For example, familiarity with diabetes process measures could stimulate diabetic patients to request eye exams or track their level of blood sugar control. Finally, comparative performance data could augment existing public health mechanisms for tracking the incidence and prevalence of certain types of diseases and interventions.
The government programs should explore mechanisms for pooling the performance data needed to evaluate and compare quality across populations and programs. Pooled data could support quality enhancement at both the micro and macro levels; pooled Diabetes Quality Improvement (DQIP) data, for example, can help identify geographic, provider-level, and program-specific variations in the quality of diabetes care.
Private entities could also participate in the data repository, as long as they satisfy safeguards to assure data validity and reliability. The ability afforded by such a pool to enable broader, more population-based comparisons gives private plans an incentive to participate both to improve provider selection and evaluate their own performance.
The Agency for Healthcare Research and Quality (AHRQ) is well positioned to work with participating programs in developing and managing a pooled data repository. In designing the repository, AHRQ should get consumer and other stakeholder input. AHRQ’s research orientation provides the technical and analytical expertise needed to assess the validity of data to develop reporting and data access strategies to meet the needs of various users. In establishing the repository, AHRQ will need to assure compliance with HIPAA requirements for patient privacy. It is anticipated that any patient-level data would be stripped of identifiers.