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December 24/31, 2003

Farming and Slaughterhouse Practices to Reduce Meat-Borne Disease—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(24):3194-3195. doi:10.1001/jama.290.24.3194-a

In Reply: Dr Cobin and colleagues, representing the Physician Consortium for Performance Improvement, suggest that performance measurement should be used for QI activities and that efforts should be directed at the development of improved measurement tools and infrastructure. We agree that performance measurement for QI purposes need not meet the stringent set of requirements that we suggested in our article.

We note, however, that "pay for performance" systems already are being implemented, and that many of these systems rely on physician clinical performance assessment.1 Similar to performance measurement for competency assessment, the requirements for clinical performance assessment to reward quality should be stringent because of the potential impact on income and reputations. There currently are few data on such "pay for performance" systems, but many of the same issues that we raised in our article are relevant for this topic as well. Consequently, better evidence is needed to support the use of these systems and to ensure that their implementation does not lead to unintended consequences, whether with respect to unmeasured aspects of care or to access problems for specific types of patients.

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