would impose an enormous burden on providers, institutions, and health care professionals. More important, the time and resources available to providers to support quality improvement efforts would increasingly be consumed by data collection across a wide range of measures, resulting in less time and fewer resources available for the redesign of care processes.

It also became clear that many stakeholders would use standardized measures and data for a variety of purposes, including public reporting, pay for performance, quality improvement, and professional certification. The existing patchwork of measurement and reporting efforts could not be relied upon to respond to the diverse information needs of consumers, purchasers, providers, and other stakeholders. Publicly available performance information varied greatly in terms of availability by geographic area, participation of various types of providers, comprehensiveness and relevance of quality measures, validity and reliability of data, and usefulness of public reporting formats. Health care leaders recognized the need for a national infrastructure and process for setting goals and priorities for performance measurement and improvement, promulgating standardized measure sets for use by all stakeholders, and streamlining data collection and reporting.

In 1998, the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry identified key components of a national quality strategy and infrastructure, including (1) the promulgation of a set of aims for improvement, accompanied by specific, measurable objectives; and (2) a measurement and reporting system consisting of standardized measures and data collection and reporting capabilities. The commission also recommended creating two public–private partnership entities (President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998):

  • Advisory Council for Health Care Quality—The expert advisory council would identify national aims and specific objectives for improvement, establish goals and objectives for measurement, and track and report on the nation’s progress. The council would be located in the public sector and publicly financed.

  • Forum for Health Care Quality Measurement and Reporting—The forum would define a plan for implementing quality measurement, data collection, and reporting standards, and identify and update core sets of quality measures and standardized reporting methods. The forum would be a private-sector membership organization, financed by member dues.

In 1999, the private-sector component, NQF, was established by a Forum Planning Committee convened under the auspices of the office of the Vice President of the United States. However, the public-sector component (the Advisory Council for Health Care Quality) was not established by



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