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In Reply: Drs Amundson and Isham raise a useful question on the presentation of performance data. We believe that there is no single correct way to present these data. Although we used a presentation that we expected would be useful to readers, Amundson and Isham's approach may be more useful in demonstrating the magnitude of the problem. A limitation of their approach is that it can be relatively insensitive to progress. If, for example, the number of patients with pneumonia who receive prompt treatment and appropriate antibiotics improves sharply but there is no improvement in immunization rates, their indicator would fail to reflect this improvement.

Stephen F. Jencks, MD, MPH
Office of Clinical Standards and Quality
Centers for Medicare & Medicaid Services
Baltimore, Md

Edwin D. Huff, PhD, MA
Division of Clinical Standards and Quality Care
Centers for Medicare & Medicaid Services
Boston, Mass

Timothy Cuerdon, PhD
Health and Behavioral . . . [Full Text of this Article]

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Measuring Improvement in Quality of Care
Gail M. Amundson and George Isham
JAMA. 2003;289(20):2647.
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