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Who Is Responsible for What?

J. Frank Wharam, MB, BCh, BAO, MPH; Daniel Sulmasy, OFM, MD, PhD

JAMA. 2009;301(2):215-217.

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

Suboptimal health care quality is an urgent national concern.¹ Recently, policy makers have sought to improve quality by providing bonus dollars to physicians whose patients achieve certain health goals.² The privatized US health care system has engendered decentralized quality improvement approaches³ and an unintended consequence has been ambiguity regarding who is responsible for quality and the scope of stakeholders' obligations. For example, some pay-for-performance arrangements effectively pay physicians less if their patients with diabetes miss appointments and fail to take prescribed medications.^4-5 Pay-for-performance also does not typically assess diagnostic skills or clinician empathy,³ traits that patients value highly.⁶ These measurement flaws have frustrated physicians^{5, 7} and a backlash could derail potentially valuable improvement efforts.

In this Commentary, the stakeholders responsible for improving health care quality are identified and their shared and unique obligations are outlined. The resulting framework may . . . [Full Text of this Article]

Quality Health Care: What Is It and Who Is Responsible?

Quality Health Care for Individual Patients

Quality Health Care for Populations

Pay for Performance as a Quality Improvement Approach

Quality Improvement in General

Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Dr Wharam); and St Vincent's Hospital, Manhattan and New York Medical College, New York (Dr Sulmasy).

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