treated only five patients for congestive heart failure, because if a random event has occurred, her performance rating will be skewed.

  • Weighting of elements for composite measures—The issue here is whether to place more emphasis on any particular component of a composite measure, as discussed in Chapter 4. For example, weighting of components of the prevention composite measure would address whether a physician treating a woman with a history indicating an increased risk of breast cancer should be scored higher for providing this screening as opposed to giving smoking cessation advice.

  • Shared accountability—As noted, the committee espouses the concept of shared accountability as a way to encourage better care coordination and to shift away from measuring and rewarding care by setting. Models are needed for determining how best to hold accountable all providers involved in a patient’s care—e.g., a group of providers who prevented hospital readmission for a typical Medicare beneficiary with four chronic conditions—and to reward high-quality care.

Resolution of these methodological issues is critical for accurate data reporting. The NQCB should therefore ensure that these issues, as well as others it deems important, are promptly addressed.


If performance measures are to have the intended effects on the way care is provided, as well as on the health outcomes of patients, it is essential that they be reported so as to be clear and meaningful for those who wish to use the data. There is a broad audience for public reports on care, ranging from providers and purchasers to patients. To date, attention has focused mainly on how purchasers and providers respond to public reports and how their responses affect their behaviors; little attention has been focused at the patient level. Additionally, reports often are not tailored to the needs of special populations who may vary widely in their specific health information needs, language, and level of health literacy. The committee believes the usability of public reports of comparative health care performance data needs to be a focus of further research, as these reports currently are not produced in formats that resonate with consumers. Inadequate or inaccurate public reports can undermine the confidence of both consumers and clinicians in the value of public disclosure of performance information. Knowing what measures are meaningful to consumers is also important. Reports need to be produced so they can be understood by consumers and assist those searching for a provider (Farley Short et al., 2002; Hibbard et

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