An evidence-based national quality measurement and reporting system.
BACKGROUND
Evidence-based medicine and evidence-based guidelines are widely supported among physicians and other health professionals, although practice may still fall far short of the ideas contained in the concept. Insufficient attention has been given to using the concepts of evidence-based practice in the selection of measures, diffusion of innovations, and adoption of quality improvement (QI) techniques.


OBJECTIVE
To describe in greater detail how evidence serves as a foundation for a national quality measurement and reporting system (NQMRS) and to consider the different types of evidence that will be used. The role of the NQMRS in adding to the evidence base is explored.


METHODS
A descriptive, conceptual discussion.


RESULTS
Many different types of evidence are available for use in the NQMRS. The NQMRS could add substantial new evidence on how well different approaches to quality measurement, reporting, and improvement work and also expand the evidence base on the effectiveness of clinical interventions for which efficacy has been established.


CONCLUSIONS
An evidence-based NQMRS will require substantial leadership from government and private entities. The gains from a greater focus on evidence are expected to be found in accelerating QI. Reliance on evidence-based approaches should not be used to stifle innovation.
McGlynn
Elizabeth A
EA
RAND Health, Santa Monica, California 90401, USA. mcglynn@rand.org
D019352:Censuses; D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine; D006076:Government; D006801:Humans; D007857:Leadership; D009309:National Center for Health Statistics, U.S.; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care / Q000592:standards*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality