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.