Measuring the Cost of Quality Measurement

Less than 2 decades after publication of the National Academy of Medicine’s (formerly the Institute of Medicine) Crossing the Quality Chasm: A New Health System for the 21st Century, quality measurement has become routine and widespread throughout the US health care system.1 From accountability to accreditation, from quality improvement to research, measures are everywhere. Although quality measurement activities are motivated, at least in part, by a desire to improve care, the current approach has produced an explosion of measures and a measurement system characterized by inefficiency and imbalance, with measures that are duplicative (eg, multiple measures of follow-up care for the same condition that use different periods), that are overlapping (eg, a diabetes composite measure and a separate hemoglobin A1c measure), or that overrepresent some areas of care (eg, there are many measures covering childhood immunizations and relatively few covering chronic care for children). Given that collecting, processing, analyzing, and reporting quality data are costly in time and resources2—resources that are often taken from direct patient care when these activities involve physicians and other clinicians—there has been an increasing call to rein in the proliferation of measures by identifying a small set of high-priority measures.3