plied research programs sponsored by VHA, the National Institutes of Health, and the Centers for Disease Control and Prevention, the federal government can and has assisted in the development of quality measures, survey instruments, and public reporting tools. The federal government also supports applied health services research that addresses many of the broader health care financing and delivery issues whose resolution is important to creating an environment that supports quality.

RECOMMENDATION 2: The federal government should take maximal advantage of its unique position as regulator, health care purchaser, health care provider, and sponsor of applied health services research to set quality standards for the health care sector. Specifically:

  1. Regulatory processes should be used to establish clinical data reporting requirements applicable to all six major government health care programs.

  2. All six major government health care programs should vigorously pursue purchasing strategies that encourage the adoption of best practices through the release of public-domain comparative quality data and the provision of financial and other rewards to providers that achieve high levels of quality.

  3. Not only should health care delivery systems operated by the public programs continue to serve as laboratories for the development of innovative 21st-century care delivery models, but much greater emphasis should be placed on the dissemination of findings and, in the case of information technology, the creation of public-domain products.

  4. Applied health services research should be expanded and should emphasize the development of knowledge, tools, and strategies that can support quality enhancement in a wide variety of settings.

Congress should provide the appropriate direction, enabling authority, and resources to the government health care programs for carrying out this mandate.


At present, the federal government is seriously hampered in performing its purchasing, regulatory, and provider functions by a lack of information on clinical quality—the degree to which the care received by beneficiaries is consistent with the science base (i.e., effective) and provided in a technically competent fashion (i.e., safe).

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