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Commentary
June 16, 2010

Quality of Care—How Good Is Good Enough?

Author Affiliations

Author Affiliations: Dartmouth Medical School and the Dartmouth Institute, Hanover, New Hampshire (Dr Sox); and the University of California–Irvine (Dr Greenfield).

JAMA. 2010;303(23):2403-2404. doi:10.1001/jama.2010.810

Measuring the quality of health care is the basis for establishing accountability for providing good care. Yet although the science of quality measurement is steadily improving, the methods for setting a threshold for acceptable care are still rudimentary. In holding physicians accountable, when is care good enough to be acceptable? How good is good enough?

According to current practice, a payer judges a physician or a practice organization by the proportion of patients for which the physician adhered to the practice measure. “Good enough” therefore is an adherence rate that exceeds a threshold, which is typically expressed as a percentile of the distribution of adherence rates in a population of clinical practices. For example, in its recognition program, the National Committee for Quality Assurance sets the threshold for passing a measure according to the population-derived adherence rate for the corresponding Healthcare Effectiveness Data and Information Set (HEDIS) Health Plan measure (usually at the 70th percentile) (Gregory Pawlson, MD, National Committee for Quality Assurance, e-mail communication, April 2010).

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