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To the Editor: Dr Walter and colleagues find much to approve of in the Veterans Health Administration's (VHA's) system of performance measures—a key aspect of our improvements in quality health care over the past 10 years.^1-3 However, the significant criticisms of our system that they offer require response.

The VHA's performance measures are developed by panels of clinicians, researchers, and quality experts (our Performance Measurement Workgroup) and undergo periodic evidence reviews. We set the benchmark for 18 externally comparable measures of disease prevention and treatment, from immunization to cancer screening. Our clinical performance measurement system focuses attention on problem areas and drives appropriate change. It is a significant part of VHA's strategy to provide world-class health care to 5 million veterans annually.

Colorectal cancer screening is one of many quality measures VHA continually evaluates and strives to improve. Most VA patients are well-served by regular CRC screenings, which are supported . . . [Full Text of this Article]

Barbara B. Fleming, MD, PhD
barbara.fleming@hq.med.va.gov
Department of Veterans Affairs
Veterans Health Administration
Washington, DC

Robert A. Petzel, MD
VA Midwest Health Care Network
Minneapolis, Minn
For the Performance Measurement Workgroup

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