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To the Editor: Dr Landon and colleagues¹ described a number of difficulties with the use of clinical outcomes to assess physicians' competence. We agree with their conclusion that clinical performance assessment for this purpose currently is not feasible.

Although Landon et al described "tension" between the use of performance measurement for global quality improvement (QI) vs individual performance assessment, we think that this could be resolved through a clearer understanding of the role of such data. Thus, on behalf of the Physician Consortium for Performance Improvement, convened by the American Medical Association,² we propose a greater consensus for the use of such measurement for QI. This proposal will require an overall electronic infrastructure to ensure data integrity.

Recognizing current limitations on the feasible uses of performance measurement, the consortium focuses on developing measurement tools useful to physicians for facilitating QI at the point of care. These measures require no minimum . . . [Full Text of this Article]

Rhoda H. Cobin, MD
Department of Medicine
Mount Sinai School of Medicine
Midland Park, NJ

Bernard M. Rosof, MD
North Shore-Long Island Jewish Health System
Great Neck, NY

Carl A. Sirio, MD
Division of Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, Pa

Josie R. Williams, MD, MMM
Rural and Community Health Institute
Texas A&M University System Health Science Center
Bryan

for the Physician Consortium for Performance Improvement

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