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Invited Commentary
December 2016

The Quest to Improve Quality: Measurement Is Necessary but Not Sufficient

Author Affiliations
  • 1Kaiser Permanente Research, Pasadena, California
  • 2Departments of Veterans Affairs Center for Clinical Management Research and Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2016;176(12):1790-1791. doi:10.1001/jamainternmed.2016.6233

Thirteen years ago, we reported that American adults were receiving about half of recommended care for the 30 leading causes of illness and death.1 We used 439 indicators covering inpatient and outpatient care that were validated through a modified Delphi process. Indicators were scored using data abstracted from all physicians seeing participants supplemented by survey data. We also found that quality deficits were similar across very different communities2 and that everyone was at risk for experiencing substandard quality.3 These findings caught the public and health professionals by surprise, although they were consistent with prior small studies. Since then, there has been a proliferation of public and private programs to measure, publicly report, and reward or penalize health plans, hospitals, physicians, and other care settings on quality.