Editorial |

Clinical Performance Measurement—A Hard Sell

Stephen F. Jencks, MD
JAMA. 2000;283(15):2015-2016. doi:10.1001/jama.283.15.2015.
Text Size: A A A
Published online


Publication of comparative performance data does not automatically produce improved clinical performance. The effectiveness of the marketplace to promote improved care, if only accurate quality measurement can be made available, is an article of faith among some students of health policy because market forces are an attractive alternative to increased government regulation. The reality is more complex.

For years, there was serious debate as to whether quality of care was measurable at all. Today, there is substantial consensus that quality can be measured in some important areas of health care. For the last decade, purchasers and business coalitions have pressed for collection and publication of data on outcomes and critical processes of care so the marketplace can promote quality. The health care community has been buffeted by demands for more data on practitioner, provider institution, and health plan performance and beset by the burdens of data collection and the difficulties of producing accurate, risk-adjusted information. While there is some disagreement about what aspects of care are considered quality, there is little disagreement that the effectiveness of care in bringing about desired outcomes is an important aspect of quality. In particular, survival rates for elective surgery, if properly adjusted for patient risk, have high face validity as a measure of hospital and surgeon performance.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 30

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles