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Research Letter
February 3, 2015

Quality Measures Based on Presenting Signs and Symptoms of Patients

Author Affiliations
  • 1Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles
  • 2RAND Corporation, Boston, Massachusetts
  • 3Department of Medicine, University of California, Los Angeles
  • 4Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
JAMA. 2015;313(5):520-522. doi:10.1001/jama.2014.17550

Health care reform efforts, such as accountable care organizations, focus on improving value partly through controlling use of services, including diagnostic tests. Some have expressed concern that these efforts may result in delayed diagnosis and subsequent patient harm.1 Publicly reported quality measures that evaluate care provided prior to arriving at a diagnosis could prevent financial incentives from producing harm.

The Institute of Medicine (IOM) previously developed a conceptual framework for categorizing process quality measures.2 The IOM framework includes criteria related to prevention, screening, evaluation/diagnosis, management, and follow-up.2

The National Quality Forum (NQF) currently serves as the consensus-based quality-measure–endorsement entity called for in the Affordable Care Act. Measures are submitted to the NQF by professional societies, government agencies, health systems, nonprofit organizations, and industry. Multistakeholder expert committees assess proposed measures using specific evaluation criteria. Endorsed measures are often adopted by the Centers for Medicare & Medicaid Services in payment and public reporting programs.3