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To the Editor: In their Commentary, Dr Pronovost and colleagues¹ discussed generally accepted accounting principles (GAAP) and quality measurement. Although we agree that a standardized reporting system using GAAP as a model is a good idea in theory, there are several cautionary lessons from a relatively simple system like accounting to keep in mind when compared with the complexities of quality assurance measurements in medicine.

Information conveyed in external reports may lack detail required by internal reports, and vice versa. Therefore, the level of detail to be included in a GAAP-style report must be specified for either external or internal audiences. It is not unusual for basic financial statements that consist of a balance sheet, income statement, statement of changes in equity, and statement of cash flows (often 4 pages) to be followed by a footnote section that can be more than 20 pages long.² Companies may also have to . . . [Full Text of this Article]

Dev Jayaraman, MD, FRCP
dev.jayaraman@mcgill.ca
McGill University Health Center
Montreal, Quebec, Canada

Howard Rivenson, PhD
Harvard School of Public Health
Boston, Massachusetts

RELATED ARTICLE

The GAAP in Quality Measurement and Reporting
Peter J. Pronovost, Marlene Miller, and Robert M. Wachter
JAMA. 2007;298(15):1800-1802.
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RELATED LETTER

Accounting Principles and Measuring Health Care Quality—Reply
Peter J. Pronovost, Marlene Miller, and Robert M. Wachter
JAMA. 2008;299(7):764-765.
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