Measuring and Improving Quality in the US: Where Are We Today?

Area of Science:

• Health Services Research
• Medical Quality Improvement
• Healthcare Policy

Background:

• The American Board of Family Medicine (ABFM) was established 50 years ago amid a perception of high-quality care.
• Awareness has since grown regarding significant and pervasive quality issues in U.S. healthcare.
• Despite various quality improvement efforts, systematic progress remains elusive.

Purpose of the Study:

• To evaluate the effectiveness of quality improvement strategies implemented over the past 50 years.
• To examine the impact of financial incentives on healthcare quality.
• To propose a new direction for quality measurement and assessment led by the ABFM.

Main Methods:

• Review of quality improvement programs, including public reporting, pay for performance, and value-based purchasing.
• Analysis of the role of maintenance of certification, systematic reviews, practice guidelines, and electronic health records.
• Assessment of the evidence linking financial incentives to quality outcomes.

Main Results:

• Limited evidence suggests systematic quality improvement in the United States.
• Some areas show improvement, while others remain stagnant or have declined.
• Financial incentives show little correlation with demonstrable quality improvements.

Conclusions:

• Current quality improvement strategies, particularly financial incentives, may not be effective.
• Healthcare quality is a complex systems issue requiring systemic solutions.
• The ABFM has a critical opportunity to lead in redefining quality measurement and assessment.