reviews. Other measures require asking patients to complete surveys that allow assessment of their perceptions of their care, their quality of life, or their functional status.

  • Data verification and auditing—A key element of a quality measurement and reporting system is ensuring that data for performance measures are reported accurately. For many measures that are submitted by individual providers (i.e., self-reported), an external auditing function is often desirable and, for some regulators, mandatory.

  • Comparative analysis and reporting capability—A performance measurement system that produces information to support the decisions of consumers, purchasers, referring physicians, and other stakeholders in choosing plans, providers, or treatment options requires some form of effective comparative reporting capability. Similarly, improvement efforts that draw on knowledge of best practices benefit from comparative data.

While the current proliferation of measure sets and related reporting activities provides important building blocks for a performance measurement and reporting system, it may have unintended consequences. The above components frequently draw upon different data sets. Excessive attention and energy may be required of providers to comply with externally imposed reporting requirements and quality improvement priorities. These resources may be diverted from patient care and internally generated quality improvement efforts. External reporting requirements that fail to yield readily understandable, pertinent, and reliable information may result in frustrated consumers and angry providers. It is not surprising, then, that numerous expert panels have identified the need for greater standardization of performance measures and reporting requirements (IOM, 2002; President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998).

This chapter includes three sections. The first provides an overview of recent efforts to promote standardized quality measurement and reporting. The second lays out a rationale for a national system for performance measurement and reporting. The final section draws on this analysis and the work of other groups to define the key attributes of an effective national system, including 10 design principles the committee believes should guide the system’s development.


Efforts to standardize quality measurement and reporting in the health care system have been under way for more than 15 years. Of particular significance are the early pioneering efforts of NCQA, the Agency for

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