gies that incorporate these measures and offer an evaluation of the Quality Improvement Organizations that work under contracts with Medicare.

Congress, the public, and numerous other stakeholders concerned about the persistent quality gaps and rapidly rising costs of health care in the United States have high expectations that public reporting, pay for performance, and quality improvement initiatives can help realize the transformational change envisioned in the Quality Chasm report. As noted above, however, the full potential of these initiatives cannot be realized without a coherent, robust, integrated performance measurement system that is purposeful, comprehensive, efficient, and transparent. Such a system should link performance measures directly to explicit national goals for improvement. The performance measurement process should include audits to ensure the measures themselves are sufficiently accurate and reliable to yield credible data. The measurement process should also be streamlined to improve its value while reducing its costs. Its results should be open and available to all stakeholders.

The committee fully recognizes that many public- and private-sector initiatives have made substantial progress in developing, implementing, and reporting on measures of provider performance. These efforts have yielded a laudable array of assets for performance measurement. However, the committee believes a well-functioning national system that can meet the need for performance measurement and reporting is unlikely to emerge from current voluntary, consensus-based efforts, which are often fragmented and lack a consistent connection to explicit, overarching national goals for health care improvement. In short, while recent efforts offer some promise, the committee believes a bolder national initiative is required.

The current approach to quality measurement in the United States is unlikely to evolve on its own into an effective national system for performance measurement and reporting for the following reasons, among others:

• National goals are unlikely to be set and translated into measures, since existing entities have neither the authority nor the overarching leadership required to formulate such goals.

• Gaps in performance measurement, such as the capacity to measure equity and access, are unlikely to be filled because of the lack of clear ownership of these aspects of the nation’s quality improvement agenda.

• Wasteful duplication and inconsistencies among measures will continue, since no single stakeholder group has the standing to require others to use specific, standardized definitions and measurements.