to develop a business case either supporting or refuting the need for the National Quality Coordination Board (NQCB). Moreover, the NQCB as envisioned by the committee will be a learning system. Thus it will be necessary to understand how well the entire system is functioning and to what extent these efforts to improve quality are affecting health and processes of care.

Recommendation 5: The NQCB should formulate and promptly pursue a research agenda to support the development of a national system for performance measurement and reporting. The board should develop this agenda in collaboration with federal agencies and private-sector stakeholders. The agenda should address the following:

  • Development, implementation, and evaluation of new measures to address current gaps in performance measurement.

  • Applied research focused on underlying methodological issues, such as risk adjustment, sample size, weighting, and models of shared accountability.

  • Design and testing of reporting formats for consumer usability.

  • Evaluation of the performance measurement and reporting system.

Advances in the quality of health care delivery will be markedly slower without a performance measurement and reporting system that articulates a focused research agenda. The NQCB should take responsibility for leading efforts to develop such a research agenda and to ensure its timely implementation. In this role the board will need to have contracting and grantmaking authority to support external research as well as the internal capacity to perform this function. To provide a base for these efforts, the Agency for Healthcare Research and Quality (AHRQ) and other stakeholders—both public and private—should take steps now to assess and sponsor developmental work addressing current barriers to performance measurement and reporting. The following sections address how action on the four fronts enumerated above can advance a national performance measurement and reporting system designed to enhance the quality of health care delivery.


Current efforts to develop performance measures to fill some of the gaps identified in Chapter 4 are unlikely to succeed without the more coordinated and effective leadership that the NQCB can provide in prioritizing and adequately funding a targeted research agenda to address those gaps.

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