Provider- and Plan-Specific Measures of Quality

health care provider-specific performance can be useful tools for informed decisionmaking by consumers, purchasers, and regulators. Additionally they can stimulate improvements in the quality of care and provide insight in targeting of quality improvement activities. Following up on the spring 2001 issue of the Review on performance measures for health plans, this issue addresses provider-specific measures of quality and refinements to existing plan-specific measures. The first five articles in this issue of the Health Care Financing Review report on recent initiatives to develop and implement new provider-specific measures of quality in health care delivery, focusing on settings other than health plans. This set of articles provides insights into the processes used in the design, development, and implementation of these initiatives and each offers lessons learned for future work. Aspects addressed in these articles include the crafting of the measures as well as the challenges of presenting, explaining, and disseminating the information to the public. The spectrum of providers covered includes nursing homes, dialysis facilities, hospitals, and primary care case management programs. These new initiatives have balanced concerns of validity, reliability, timeliness, and value to the user. Despite acknowledged shortcomings, these projects have expanded the information available to the public and to health care providers, often under constraints of aggressive timelines to meet legislative mandates. The authors acknowledge that each of these projects is only a first step, and relay that the importance of advancing the quality process outweighs limitations in the indicators. Use of these new measures affords opportunities for continued improvement and evolution of the measures, their implementation, and the supporting communication strategies. The next four articles in this theme focus on refinements and new applications of existing quality measurement tools used in health plans. These studies illustrate the further evolution and application of established quality measures. The contrast between the levels of refinement in these two sections of this issue highlights the advancements that have been made in quality measurement for health plans, a health care delivery setting that has a history of systematically using established quality measures.