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Bad Apples or Bad Systems?

David C. Hsia, JD, MD, MPH

JAMA. 2003;289:354-356.

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

The Quality Improvement Group at the Centers for Medicare and Medicaid Services leads the quality improvement organizations (QIOs, formerly the PROs [peer review organizations], PSROs [professional standards review organizations], EMCROs [experimental medical care review organizations], etc),¹ and according to the results of a study by Jencks and colleagues² in this issue of THE JOURNAL, their leadership is effective. No other US organization measures quality at the hospital level. The QIO program uses 24 quality indicators that have strong evidence to support them. Jencks et al report that between 1999 and 2001, the proportion of Medicare patients receiving appropriate care improved from 70% to 73% on average, although this rate varied widely across states and by indicator.² Their analysis is valid, robust, understandable, and correct. For the 1999-2002 QIO contract cycle, Centers for Medicare & Medicaid Services required all QIOs to improve quality in 5 . . . [Full Text of this Article]

Author Affiliation: Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Md.

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