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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor.—While we applaud the efforts of Drs Lundberg and Wennberg¹ with their challenge to the medical profession, a challenge that has been notably long absent, their call already has been answered, at least in part, and, ironically, reported in JAMA.²

Structurally, the suggested framework of their proposal for a program addressing quality improvement currently exists in the Health Care Financing Administration Peer Review Organization (PRO) program that has been in place since 1984. This quality improvement infrastructure, required by the Social Security Act for the Medicare program, is in place for every state and US territory. Despite past references to governmental slowness, the Health Care Financing Administration remains at the forefront of quality improvement with its PRO Health Care Quality Improvement Initiative. Specifically, PROs, in conjunction with local and national collaborators, already identify high prevalence and high impact medical conditions as targets for quality improvement and . . . [Full Text of this Article]

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RELATED ARTICLE

A JAMA Theme Issue on Quality of Care: A New Proposal and a Call to Action
George D. Lundberg and John E. Wennberg
JAMA. 1997;278(19):1615-1616.
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