title: The evolution of healthcare quality measurement in the United States.
abstract: Quality measurement is fundamental to systematic improvement of the healthcare system. Whilst the United States has made significant investments in healthcare quality measurement and improvement, progress has been somewhat limited. Public and private payers in the United States increasingly mandate measurement and reporting as part of pay-for-performance programmes. Numerous issues have limited improvement, including lack of alignment in the use of measures and improvement strategies, the fragmentation of the U.S. healthcare system, and the lack of national electronic systems for measurement, reporting, benchmarking and improvement. Here, we provide an overview of the evolution of U.S. quality measurement efforts, including the role of the National Quality Forum. Important contextual changes such as the growing shift towards electronic data sources and clinical registries are discussed together with international comparisons. In future, the U.S. healthcare system needs to focus greater attention on the development and use of measures that matter. The three-part aim of effective care, affordable care and healthy communities in the U.S. National Quality Strategy focuses attention on population health and reduction in healthcare disparities. To make significant improvements in U.S. health care, a closer connection between measurement and both evolving national data systems and evidence-based improvement strategies is needed.
authors.affiliation: National Quality Forum, Washington, DC, USA.
authors.forename: H
authors.initials: H
authors.lastname: Burstin
authors.affiliation: National Quality Forum, Washington, DC, USA.|Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Leatherman
authors.affiliation: Institute for Healthcare Improvement, Cambridge, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Goldmann
mesh_terms: D019985:Benchmarking / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000592:standards; D055818:Public-Private Sector Partnerships / Q000592:standards; D011785:Quality Assurance, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
keywords: disparities; efficiency; health care; international comparisons; quality