THE DEMANDS and the needs for better measures of quality of care are now compelling issues. The demands arise from those who would use performance data as at least one basis for selecting good hospitals, physicians, and other care providers. Corresponding needs exist within health care organizations and among external review entities, such as accrediting bodies and peer review organizations. In this regard, the excellent review by Sanazaro and Mills1 in this issue of The Journal is both timely and worrisome.
Generic occurrence screens today are commonly accepted as the state-of-the-art performance measures. However, their limitations are becoming increasingly apparent as more sophisticated approaches to quality assessment are being developed. Meanwhile, would-be data purveyors are establishing their own databases or are drawing performance information from databases that were not designed to support quality assessment activities. Professional frustration over data misuse and misinterpretation is now widespread.
The professional community faces