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To the Editor: In their Commentary, Drs Werner and McNutt¹ addressed strategies to improve quality, considering the balance of internal quality projects vs external monitoring. However, they did not clarify the very useful distinction between selection data and quality improvement data.

Berwick et al² noted the necessity of external selection data for a variety of uses. At the same time, internal quality improvement measures are essential to the learning organization. This distinction is increasingly vivid because the public expects data for quality monitoring.³ It is helpful for clinicians to understand that some metrics are for selection, some metrics are for quality measurement, and the roles of some metrics will vary.

Financial Disclosures: Dr Schumacher reported being president of the Rockburn Institute, a health services research and consulting organization; clinical informatics officer for Crozer-Keystone Health System; external quality compliance officer for Long Island Health Network; consultant for Bon Secours Health System; . . . [Full Text of this Article]

Dale N. Schumacher, MD, MPH
dsrockinst@aol.com
Rockburn Institute
Elkridge, Maryland

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