challenges that must be confronted, including measurement at the level of individual physicians/groups and accountability for quality concerns that cut across providers and settings.

Chapter 5 calls for the federal government to work collaboratively with the private sector to establish processes for reporting, analyzing, and releasing performance measurement data. Under the national quality enhancement strategy recommended in this report, providers would submit performance data using standardized measures, and comparative performance data would be made available at various levels of detail to consumers, health care providers, purchasers, regulators, and other stakeholders. This chapter examines why a more sophisticated information infrastructure is critical both to the implementation of this quality enhancement strategy and to the achievement of threshold improvements in quality over the coming decade. It also explores the need for well-thoughtout processes for the analysis, interpretation, and release of performance data.

Lastly, a strong health services research capability will be necessary to enable the establishment of standardized measures and public reporting functions across the various government health care programs. Chapter 6 provides an overview of current health services research activities related to quality oversight that are carried out by the various federal agencies. It also provides a rationale for a more coordinated process for development of a national health care quality research agenda.

Three appendices are also included. Appendix A is a list of the acronyms used in the report. Appendix B shows the performance measurement set that resulted from the Diabetes Quality Improvement Project, an effort to develop a standardized set of process and outcome measures for performance reporting related to the care of adults with diabetes. Finally, Appendix C presents a technical overview of the health information systems of VHA and DOD.


Advisory Commission. 1998. Quality First: Better Health Care for All Americans. Final Report to the President of the United States. Washington DC: U.S. Government Printing Office.

Berwick, D. M. 2002. A user’s manual for the IOM’s “Quality Chasm Report”: patients’ experiences should be the fundamental source of the definition of “quality”. Health Aff (Millwood) 21 (1):80-90.

Centers for Medicare and Medicaid Services. 2002. “National Health Expenditures Projections: 2001-2011.” Online. Available at [accessed March 20, 2002].

Chassin, M., and R. Galvin. 1998. The urgent need to improve health care quality: Institute of Medicine National Roundtable on Quality. JAMA 280 (11):1000-05.

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