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To the Editor: Dr Jencks and colleagues¹ reported that states' performance on 22 indicators of medical quality improved by an overall 3% between 1998-1999 and 2000-2001 although there was significant variation between states. The data were quite complex; with 52 state rates for 22 quality indicators, there was a total of 1144 individual outcomes. The authors assisted interpretation of this large data set by providing a state ranking for each indicator and calculating an overall state ranking using the average of individual indicators' relative rankings. Studies have found, however, that most people can generally assimilate only 5 to 7 variables in such a quality assessment.²

Thus, we believe that patients would be most interested in a single global indicator of care, which would describe the proportion of patients receiving care consistent with best practice. For acute myocardial infarction, for instance, such an index would reflect the proportion of patients who . . . [Full Text of this Article]

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