Do Cardiology Quality Measures Actually Improve Patient Outcomes?

C ardiovascular quality measures for inpatient care haveundergone a rapid evolution over the past three decades. Isolated efforts at simply measuring quality have developed into national programs dedicated toward the public reporting of hospital performance on a number of quality measures. Most recently, performance on quality measures has become closely tied to hospital and physician payments. With the implementation of the Affordable Care Act (ACA), further changes in how we measure, report, and pay for quality health care will continue in coming years. At their core, quality measures in cardiovascular care are meant to improve the quality of care delivered to patients, and in doing so, improve patient-relevant outcomes such as mortality, hospital readmission, and patient experience. However, the relationship between quality measures and hard outcomes has been inconsistent, and thus, problematic for policymakers and clinical leaders who aim to use these measures to effectively drive improvements in cardiovascular care. In this review, we examine the evidence behind three major mechanisms of quality improvement: measurement alone, public reporting, and pay-for-performance. In characterizing the successes and failures that have occurred as part of each of these mecha-nisms, we provide a framework to inform future quality improvement efforts.