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Letters
July 22 2009

Identifying and Improving Quality of Care

JAMA. 2009;302(4):383. doi:10.1001/jama.2009.1043

To the Editor: In their Commentary, Drs Werner and McNutt1 addressed strategies to improve quality, considering the balance of internal quality projects vs external monitoring. However, they did not clarify the very useful distinction between selection data and quality improvement data.

Berwick et al2 noted the necessity of external selection data for a variety of uses. At the same time, internal quality improvement measures are essential to the learning organization. This distinction is increasingly vivid because the public expects data for quality monitoring.3 It is helpful for clinicians to understand that some metrics are for selection, some metrics are for quality measurement, and the roles of some metrics will vary.

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