al., 2002). If these goals are not met, then public reports will have little effect, if any, on consumers and their choice of care. Emphasis in this area of research should be placed on how best to design and test formats for public reporting for consumers of health care (Shaller et al., 2003; Vaiana and McGlynn, 2002).


The NQCB should not be a static entity, but rather a dynamic learning system that continually evaluates itself and advances understanding of the impact of performance measurement. The committee proposes that assessment of the NQCB be carried out at time intervals that allow for continual improvement and midcycle corrections as needed (Deming, 1994; Langley et al., 1996). It is critical to determine whether the NQCB is having the intended consequences—ultimately the attainment of the six quality aims of the Quality Chasm—through intermediate outcomes such as better care processes. Just as important, the ongoing monitoring of the NQCB should serve to safeguard against unintended consequences, such as adverse selection. Table 5-2 presents a summary of what should be encompassed by an impact assessment of the NQCB, as discussed in detail below.

Intended Consequences

Performance measurement should yield knowledge and enable inferences about the effects of health system changes in such areas as payment policies, public reporting, benefit design, accreditation/certification, and quality oversight. Assessment of the NQCB should elucidate whether these changes to the health care system are inducing behaviors, particularly among providers, that result in improved patient care. For example, it should be possible to address the following key questions more fully as a result of the performance measurement activities overseen by the NQCB:

  • Is performance measurement contributing to a closer evaluation of care processes so that providers are capable and desirous of changing the way they organize and deliver care to achieve improved quality?

  • Does performance measurement assist providers in making wiser choices concerning the allocation of resources by addressing efficiency and the overuse of services that have been demonstrated to show no benefit or possibly even harm to patients?

  • Does performance measurement encourage more rapid uptake of information technology by physician practices, thus facilitating the exchange of patient information among multiple providers?

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