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Commentary
February 18, 2009

Transformation of Health Care at the Front Line

Author Affiliations

Author Affiliations: Agency for Healthcare Research and Quality, Rockville, Maryland (Drs Conway and Clancy); US Department of Health and Human Services, Washington, DC (Drs Conway and Clancy); and Center for Health Care Quality and Division of Health Policy and Clinical Effectiveness and Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Conway).

JAMA. 2009;301(7):763-765. doi:10.1001/jama.2009.103

Concern about escalating costs and the quality of health care delivered in the United States continues to mount.1 This has led to an increasing focus on pay-for-performance, value-driven health care and public reporting of quality and cost information. However, several authors have questioned the effectiveness of pay for performance and public reporting to improve patients' outcomes and have highlighted the potential for unintended negative consequences.26 Currently, frontline clinicians are exposed to disparate pay-for-performance programs that are often uncoordinated and not clearly aligned with producing better outcomes for patients.2,6 Evidence is produced at an astonishing rate, but its incorporation into clinical practice is difficult.

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