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In Reply: There are numerous examples of prior classifications of quality measures, including making the distinction between external quality measures (used for selection) and internal quality measures (used for improvement), as Dr Schumacher points out. Unfortunately, there are also numerous examples of how these measures have failed in their goal of both identifying high-quality care and improving quality of care.

Outcomes measures are often poorly risk adjusted and seem to have minimal effect on which physicians patients select.¹ Measuring processes of care, although evidence-based and actionable, has had little effect on patient outcomes.^2-3 To our knowledge, neither measure type has successfully been used to improve quality of care.

Because simply measuring quality has failed to translate into meaningful improvements in quality, we suggest shifting the focus away from measurement. We believe that focusing instead on improving quality at a local level would translate into more meaningful quality improvements.

Financial Disclosures: . . . [Full Text of this Article]

Rachel M. Werner, MD, PhD
rwerner@mail.med.upenn.edu
Philadelphia Veterans Affairs Medical Center
Philadelphia, Pennsylvania

Robert A. McNutt, MD
Department of Medicine
Rush University Medical Center
Chicago, Illinois

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