The focus on improving the quality of medical care in the United States through initiatives like public reporting and pay for performance is based on the belief that measuring quality of care is an essential first step in improving quality of care. Without measurement, it is implored, it will be impossible to know if the care clinicians deliver is good or bad. As a result, quality measurement has flourished and has been the foundation for quality improvement initiatives. Quality measures are publicly reported and perhaps influence consumer choice of physicians and hospitals and, therefore, create incentives to deliver high-quality care.1 They are also used to determine clinician and hospital reimbursement.2,3
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