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Med Care. 2003 Jan;41(1 Suppl):I1-7.

Introduction and overview of the conceptual framework for a national quality measurement and reporting system.

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RAND Health, Santa Monica, California 90401, USA.



Little systematic information is currently available on the level of quality of health care received in the United States. Most studies find significant deficits in quality, but without systematic information on quality at all levels in the health care system, substantial improvements in care delivery are unlikely.


The Strategic Framework Board (SFB) was established in 1999 to (1) design a strategy for a national quality measurement and reporting system (NQMRS), (2) articulate the guiding principles and priorities for a national system, and (3) identify potential barriers to successful implementation and propose possible solutions.


The SFB consisted of nine members selected for their breadth of research and experience in quality. The work was conducted as an expert deliberation, including face-to-face meetings, regular conference calls, some literature reviews on specific topics, drafting and discussion of papers, and presentation of observations and recommendations to the Board of the National Forum for Health Care Quality Measurement and Reporting.


The SFB developed a conceptual framework to organize the design of the NQMRS. The major components include: statement of purpose, selection of national goals, establishment of the NQMRS on a scientific foundation, selection of a common set of measures and effective reporting strategies, facilitation of local adoption of the system, and development of the capacity for quality improvement.


An NQMRS is essential for the nation to make improvements in quality. The work here presents a first step in designing such a system. Considerable work on making these strategies operational remains to be undertaken.

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