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Robert M. Wachter, MD

JAMA. 2006;295:2780-2783.

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

Nearly 2 decades after the prediction that an age of "assessment and accountability" would soon transform health care,¹ the quality movement has finally arrived. Driven by evidence that US medical practice comports with best evidence approximately half the time,² that large numbers of medical errors continue to occur,³ and that clinically indefensible disparities in care exist across regions⁴ and racial and ethnic groups,⁵ health care payers and the US government have decided that quality should be measured, publicly reported, and perhaps even compensated differentially. The latter trend, known as pay-for-performance, has been strongly endorsed by the Centers for Medicare & Medicaid Services.⁶

The scientific underpinnings of quality measurement are rising to the task. Donabedian's insight⁷ to divide quality into structure (how care is organized), process (what was done), and outcomes (what happened to the patient) is the quality movement's scaffolding. Its planks are thousands of research . . . [Full Text of this Article]

Unforeseen Consequences of Quality Measurement

Author Affiliation: Department of Medicine, University of California, San Francisco.

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