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To the Editor: The article by Dr Walter et al¹ illustrates why the implementation of quality measuring requires careful attention to sampling and target population. However, the issue raised in their article is not a problem of translating guidelines into measures, but rather one of implementing measures in practice. The use of a nonrandom sample of patients with severe chronic illness to examine performance on a screening measure is a problem.

In contrast, the National Committee for Quality Assurance (NCQA) implements a similar colorectal cancer (CRC) screening measure comprised of a random sample population selected from more than 80 million members of managed care organizations. The NCQA measure sets an age limit of 75 years² and excludes those with prior history of CRC. Critical aspects shared by the NCQA and the Veterans Administration (VA) include auditing the data, making multiple checks including data "cleaning," and reporting the data as both . . . [Full Text of this Article]

Greg Pawlson, MD, MPH
pawlson@ncqa.org

Sarah Hudson Scholle, DrPH, MPH; Philip Renner, MBA
National Committee for Quality Assurance
Washington, DC

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