found that the former hospitals significantly improved their performance in the clinical area studied relative to those that did not use public reports. The results of this study appear to suggest that public reports stimulate quality improvement interventions (Hibbard et al., 2005). In the absence of a strong evidence base, the committee considered three factors in developing its recommendations: (1) the scope of efforts currently under way in public reporting, payment incentives, and quality improvement that are dependent on performance measures; (2) the consequences of inaction; and (3) the merits of alternative approaches to the development of an effective national system for performance measurement and reporting.

The scope of current efforts and expectations for performance measurement are high. The Centers for Medicare and Medicaid Services (CMS), the private sector, and Congress are all committing substantial resources to performance measurement, public reporting, and quality improvement initiatives, and are now embarking on pay for performance initiatives. All of these efforts are being undertaken with the strong expectation of improving the quality of care. Indeed, it was this expectation that led Congress to request that the Institute of Medicine (IOM) provide guidance to CMS to support these efforts.

After reviewing current efforts (see Chapter 2), the committee concluded that extensive resources exist on which to build a national system, including those of national organizations such as the National Committee for Quality Assurance (NCQA), the National Quality Forum (NQF), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), as well as numerous state and regional entities. Notwithstanding these considerable accomplishments, however, the nation does not yet have a coherent, integrated system for establishing, measuring, and tracking the performance of the health care system. In fact, there is growing concern in some quarters that the current fragmented approach could create a confusing, duplicative, yet still incomplete set of activities that would absorb too many resources. As the overall enterprise is still young, it is worth asking whether the current efforts can and will evolve into the system that is needed—one in which performance is tied to national health care goals; is viewed as credible, objective, and grounded in evidence; is comprehensive in covering all of the six aims identified in the Quality Chasm report; is coordinated and forward looking; and is transparent and accessible to all stakeholders.

In its deliberations, the committee also discussed the potential consequences of failing to move forward and to capitalize on existing resources in a more systematic way. One such consequence is that the pace of change will remain slow, thus not reflecting the sense of urgency the committee views as essential to reach the point at which consistent delivery of high-quality care will become accelerated and more widespread. Another con-



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