unintended consequences of the demands imposed by the system. As noted above, measurement itself must not be viewed as capable of improving care, but as a catalyst for actions that can do so. Other potential consequences that warrant close monitoring include the potential burden of data collection on the health care system, as well as on individual providers; misclassification of providers, particularly if data are publicly reported; gaming of the system; and adverse selection of healthier patients to improve scores. Perhaps the most serious unintended consequence is that quality gaps will persist, resulting in harm to both patients and communities.


Recommendation 6: Congress should provide the financial resources needed to carry out the research agenda developed by the NQCB. The AHRQ should collaborate with Grantmakers in Health and others that have ties to local foundations to convene public- and private-sector stakeholders currently investing in various aspects of this research agenda for the purpose of identifying complementary investment strategies.

Achieving the goal of a comprehensive national system for performance measurement and reporting will require the development and implementation of new measures, methodologies, and reporting formats, as well as thorough evaluation of the system. Accomplishing these tasks will in turn require commitment from both public and private stakeholders. Collaboration among these stakeholders could jumpstart much-needed development of measures to fill the gaps identified in this report, as well as the formulation of evidence-based consensus guidelines to serve as the basis for measure development. The NQCB should receive adequate funding to ensure the implementation of a robust research agenda, such as that proposed in this chapter. The committee recommends that the NQCB work closely with AHRQ, who has an established track record in funding evidence-based health services research, and other groups that can provide linkages between foundations and community collaborations, such as Grantmakers in Health, to align investment strategies for carrying out this agenda.


AHRQ (Agency for Healthcare Research and Quality). 2003. National Healthcare Disparities Report. Rockville, MD: AHRQ.

Bodenheimer T, Lorig K, Holman H, Grumbach K. 2002. Patient self-management of chronic disease in primary care. Journal of the American Medical Association 288(19):2469–2475.

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