As the American health care system continues to undergo major structural changes, concerns about the impact of changes in delivery and financing mechanisms on quality of care are rapidly increasing.1 Most federal and state legislative proposals for health care system reform include provisions for evaluating quality.2 "Report cards" on clinical and organizational performance have generated considerable interest as a way to compare quality in alternate delivery systems.3,4 Public- and privatesector efforts to develop effective strategies to evaluate quality and facilitate quality improvement are expanding.
With this attention, quality has become a more visible, but also a more complicated and confusing, issue. Concerns about the adequacy of available approaches to assess performance and measure quality are frequent.5 Debates among policymakers, legislators, researchers, and others about matters such as what are the most important issues related to quality, how to evaluate major dimensions of quality, and how to
Kelly JT. Evaluating Quality Performance in Alternate Health Care Delivery SystemsA Critical Challenge. JAMA. 1994;271(20):1620-1621. doi:10.1001/jama.1994.03510440080038