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Tension Between Quality Measurement, Public Quality Reporting, and Pay for Performance

Steven A. Farmer, MD, PhD; Bernard Black, MA, JD; Robert O. Bonow, MD, MS
JAMA. 2013;309(4):349-350. doi:10.1001/jama.2012.191276.
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Accurate measures of outcomes are necessary to improve the quality of US health care and address geographic, socioeconomic, and racial/ethnic variations in care quality. However, 2 major initiatives that seek to improve quality—public reporting of outcomes and pay for performance (P4P)—have the potential to reduce the reliability of the administrative data on which they are often based and generate spurious estimates of performance.

Corresponding Author: Steven A. Farmer, MD, PhD, Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Ste 1006, Chicago, IL 60611 (sfarmer@nmff.org).

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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Figure. Relationship of Federal Reimbursement Change on Reporting of Adverse Events
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The data source for these graphs are from the National Inpatient Sample for all reporting states; The coding source, the Agency for Healthcare Research and Quality (AHRQ); and the statistical software to perform the analyses, STATA version 11.2 (StataCorp). We adjusted for fourth quarter 2007 changes in International Statistical Classification of Diseases, 10th Revision, Clinical Modification and the corresponding AHRQ definition of patient safety indicator 7, central line–associated bloodstream infections.

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May 15, 2013
Garth H. Utter, MD, MSc; Patrick S. Romano, MD, MPH
JAMA. 2013;309(19):1991-1992. doi:10.1001/jama.2013.4544.
May 15, 2013
Steven A. Farmer, MD, PhD; Bernard S. Black, MA, JD; Robert O. Bonow, MD, MS
JAMA. 2013;309(19):1991-1992. doi:10.1001/jama.2013.4547.
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