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May 17, 1995

Quality of Measurement or Quality of Medicine?

Author Affiliations

From the Office of the Director, Health Policy and Clinical Outcomes, Thomas Jefferson University Hospital, Philadelphia, Pa.

JAMA. 1995;273(19):1537-1538. doi:10.1001/jama.1995.03520430073043

Across the land, tens of thousands of inpatient medical records of Medicare beneficiaries are being analyzed using dozens of expert-derived "indicators" about the quality of care that was delivered. This information is then transmitted to the state-based peer review organizations (PROs), who in turn evaluate and interpret the results. Finally, dozens of newly appointed physicians from the PROs, many with advanced degrees in public health and epidemiology, fan out across their respective states to share these results with hospital medical staffs. Hospitals then agree to submit quality improvement action plans for PRO approval 30 days following these cooperative feedback sessions. Gone are the days of quality by inspection as we herald a new era of nonpunitive feedback on actual performance based on national data sets and the principles of continuous quality improvement.

Does this dramatic scenario seem familiar? Regrettably, I contend that most practicing physicians are blissfully unaware of the

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