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Thomas Nolan, PhD; Donald M. Berwick, MD, MPP

JAMA. 2006;295:1168-1170.

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

The pursuit of evidence-based medicine is now at the core of the agenda for improving health care in the United States. All major quality measurement systems use science-based indicators of proper processes of care, such as the ORYX measures of the Joint Commission on Accreditation of Healthcare Organizations,¹ the Health Employer Data and Information Sets measures of the National Committee on Quality Assurance,² the measures used by the Quality Improvement Organizations under contract with the Centers for Medicare & Medicaid Services,³ and at least 70 of the 179 measures in the 2004 National Health Care Quality Report from the Agency for Healthcare Research and Quality.⁴

Often, several individual performance measures are used to assess care of the same condition. For example, a recent summary of data on the Joint Commission on Accreditation of Healthcare Organizations' standardized performance measures included 9 measures for . . . [Full Text of this Article]

Option 1: Item-by-Item Measurement

Advantages of All-or-None Measurement

Issues and Opportunities With All-or-None Measurement

Author Affiliations: Institute for Healthcare Improvement, Cambridge, Mass.

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