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November 22/29, 2006

Consequences of the Quality Improvement Revolution—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296(20):2439. doi:10.1001/jama.296.20.2439-b

In Reply: One of the points in my Commentary was that the measures being used in today's public reporting and pay-for-performance programs are rather primitive and rote. This is not anyone's fault. The existing measures accurately reflect the immature state of the science of quality measurement, which in turn is a manifestation of our chronic underinvestment in that science (largely because there was no market for it until recently).

Now that there is real skin in the quality measurement game, it will be vital to continue to refine the measures, striving to make them more relevant to the care of complex patients with multidimensional illness and to improve our understanding of case-mix adjustment to facilitate apples-to-apples comparisons of outcomes, such as mortality. The risk raised by Dr McGovern is real. If we all unquestioningly follow existing measures and fail to do the hard work of finding better ones, not only will the science stagnate but we will fail to account for new diagnostic techniques and therapies when they materialize. Payers and regulators who promulgate quality measures and incentivize performance have a moral obligation to support efforts to improve the science of measurement and to ensure that measures reflect advances in clinical practice.