Using clinical performance measures to drive quality improvement

Using clinical performance measures to drive quality improvement requires two steps: first, measuring performance to identify and prioritize opportunities for improvement; then, after intervening to improve quality, remeasuring performance to track whether the intervention has worked. Until recently, many people doubted whether 'measuring' clinical performance was possible. Now, however, a scientific basis for measurement of clinical performance has emerged from the parent discipline of epidemiology. Although there are obvious limitations to its scope, this measurement approach is now widely used in the US in promoting quality improvement. In reviewing this approach, I will address, in turn, four issues: defining health-care quality; measuring health-care quality; using quality measurement for quality improvement; advances in clinical performance measurement.