of sites. These pilot tests should include the collection of patient-level data and the public release of comparative performance reports.

b. All six government programs should prepare for full implementation of the 15-set performance measurement and reporting system by FY 2008. The government health care programs that provide services through the private sector (i.e., Medicare, Medicaid, the State Children’s Health Insurance Program [SCHIP], and portions of DOD TRICARE) should inform participating providers that submission of the audited patient-level data necessary for performance measurement will be required for continued participation in FY 2007. The government health care programs that provide services directly (i.e., the Veterans Health Administration [VHA], the remainder of DOD TRICARE, and the Indian Health Service [IHS]) should begin work immediately to ensure that they have the information technology capabilities to produce the necessary data.

The initial set of measures should focus primarily on validated process-of-care measures. Many process measures, such as those in the Diabetes Quality Improvement Project (DQIP) set, can readily be used for quality measurement without adjusting for patients’ demographics or other risk factors. Moreover, compared with outcome measures, many process measures take less time to collect, require smaller samples, and can be collected from data that have already been recorded for other clinical or administrative purposes (Rubin et al., 2001). Process measures can also be easier to benchmark. But the measurement set should not be limited to process measures alone. Over time, incorporating outcome measures and measures of patient perceptions will allow for a richer assessment of the contributions of health care to improved patient and population health status.

The QuIC, an interagency committee with representation from the six major government health care programs, is well positioned to coordinate these activities. QuIC should coordinate its efforts with private-sector groups involved in the promulgation of standardized performance measures, such as the National Quality Forum (NQF), the National Committee for Quality Assurance (NCQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Leapfrog Group, and the Foundation for Accountability (FACCT).

The coordinating body should ensure that the design of performance measures and their dissemination reflect the participation of consumers. It should also aim to minimize the number of times providers must report patient-specific performance data. For example, standardized data on patients who are dually eligible for Medicare and Medicaid might be submitted to a clearinghouse, which would then distribute the data to the relevant programs.



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