Measuring and improving quality in the us: where are we today?

Abstract

In the 50 years since the American Board of FamilyMedicine (ABFM) was established, the United States has gone froma shared perspective that high-quality care was being routinely delivered to becoming aware of the significant and pervasive problems with quality. Efforts to stimulate improved quality have included public reporting, pay for performance, and value-based purchasing. In addition, maintenance of certification, systematic reviews of research, practice guidelines, electronic health records, and quality improvement programs have offered support for different dimensions of quality. Despite these programs and infrastructure, there is little evidence that quality has improved systematically in the United States. There are areas in which quality is better butmany other areas in which quality has remained the same or even worsened. The focus on financial incentives as a primary tool for motivating improvement may not be productive and there is little evidence fromresearch that quality varies with payment or incentives. Quality is a systems issue and requires systemsolutions. The ABFMhas had a long commitment to assessing quality and has an opportunity to lead the way in reimagining qualitymeasurement and assessment.