search Institute) identified more than 100 measures of the processes of M/SU health care developed by government agencies, researchers, clinician/professional organizations, accreditors, health systems/facilities, employer purchasers, consumer coalitions, and commercial organizations (Hermann et al., 2004). A significant number of outcome measurement instruments also have been identified by VHA (VA Technology Assessment Program, 2002). The failure of mainstream health care quality measurement and improvement efforts to incorporate a greater number of M/SU quality measures is due in part to the separation of M/SU and general health care, as discussed in Chapters 2 and 5. Because of this separation, many M/SU health care advocates, professional associations, and other organizations have undertaken efforts to develop and apply measures of the quality of M/SU health care. However, a major factor inhibiting both mainstream and specialty efforts is the lack of a quality measurement and reporting infrastructure addressing M/SU health care.

Effectively measuring quality and reporting results to providers, consumers, and oversight organizations requires structures, resources, and expertise to perform several related functions:

• Conceptualizing the aspects of care to be measured.

• Translating the quality-of-care measurement concepts into performance measure specifications.

• Pilot testing the performance measure specifications to determine their validity, reliability, feasibility, and cost.

• Ensuring calculation of the performance measures and their submission to a performance measure repository.

• Auditing to ensure that the performance measures have been calculated accurately and in accordance with specifications.

• Analyzing and displaying the performance measures in a format or formats suitable for understanding by the multiple intended audience(s), such as consumers, health care delivery entities, purchasers, and quality oversight organizations.

• Maintaining the effectiveness of individual performance measures and performance measure sets and policies over time.

These seven functions are currently performed to varying degrees for M/SU health care by multiple organizations—again often separately from general health care, but in this case the separation also exists across the public and private health care sectors. The result is the rudiments of a