Reimagining Quality Measurement | NEJM

Measure developers are creating ever more measures, and payers are requiring their use in more settings and tying larger financial rewards or penalties to performance. The authors believe that doing more of the same is misguided: "the time has come to reimagine quality measurement".

A fruitful alternative approach, in their view, would be guided by three principles:

• Quality measurement should be integrated with care delivery rather than existing as a parallel, separate enterprise; 
• It should acknowledge and address the challenges that confront doctors every day — common and uncommon diseases, patients with multiple coexisting illnesses, and efficient management of symptoms even when diagnosis is uncertain; 
• And it should reflect individual patients' preferences and goals for treatment and health outcomes and enable ongoing development of evidence on treatment heterogeneity.

A measurement system embodying these principles would require a view of the whole person and would have three components: a comprehensive inventory of each patient's health and health care needs, a mechanism for matching potential evidence-based interventions to those needs, and an assessment of patients' health goals and preferences. Together, these components would serve both care delivery and quality measurement. 

This article analyses this perspective and propose a way to reimagining quality measurement.