Achieving the Potential of Health Care Performance Measures

This report provides an overview of performance measurement in U.S. health care, and includes policy recommendations aimed at improving the performance measurement enterprise.

Specifically, they recommend how to develop better measures; when and how to use measures; and how to ensure the validity and comparability of publicly-reported performance measure data.


1. Decisively move from measuring processes to outcomes.

2. Use quality measures strategically, adopting other quality improvement approaches where measures fall short.

3. Measure quality at the level of the organization, not the clinician.

4. Measure patient experience with care and patient-reported outcomes as ends in themselves.

5. Use measurement to promote the concept of the rapid-learning health care system.

6. Invest in the "basic science" of measurement development.

7. Task a single entity with defining standards for measuring and reporting quality and cost data, similar to the role the Securities and Exchange Commission (SEC) serves for the reporting of corporate financial data, to improve the validity, comparability, and transparency of publicly-reported health care quality data.

The authors conclude that the interest in promoting a health care system that rewards performance needs to be balanced with the practical challenges faced when measuring performance. Improvement requires substantial investments in the underlying science of performance measurement, greater care in communicating measurement results, greater attention to the role of measures in quality improvement efforts, and using performance data in more strategic ways. The adoption of flawed measurement approaches that do not accurately discriminate between providers can undermine professional and public support for provider accountability, reward indiscriminately, and divert attention from more appropriate and productive quality improvement efforts.

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Health Affairs Blog Post

The Urban Institute's Robert Berenson discusses the seven policy recommendations to improve quality measurement in a post on the Health Affairs Blog.

Read the blog post and comments