Selecting Common Measures of Quality and System Performance

BACKGROUND: The President's Commission on Consumer Protection and Quality in the Health Care Industry recommended that a common set of quality measures be developed for the nation. The results of such common measures will be used to ensure accountability, select providers, and improve quality. Simultaneous consideration of top-down and bottom-up design requirements are likely to produce a set of measures that will serve policy and front-line information needs. OBJECTIVES: To articulate the criteria and process by which common measures should be selected and to illustrate the results of applying this approach in one clinical area. DESIGN: Discussions among the members of the Strategic Framework Board, development of a clinical logic model for acute myocardial infarction (AMI), and application of the criteria to existing quality measures for AMI. FINDINGS: Measures should: (1) be linked to a national goal, (2) have a clear and compelling use, (3) be parsimonious, (4) not impose undue burden on those providing data, (5) help providers improve care delivery, (6) help stakeholders make more informed decisions, and (7) balance the need for continuous improvement with the stability needed to track progress over time. The use of a clinical logic diagram highlights the importance of selecting measures related to primary and secondary prevention in reducing deaths from heart disease. The resulting measures are useful on the front lines of medicine as well as by consumers and purchasers. CONCLUSIONS: Focusing attention on the information necessary to stimulate progress on national goals provides a compelling framework for the choice of a common set of measures.