BMJ Qual Saf doi:10.1136/bmjqs-2012-001081
  • Viewpoint

More quality measures versus measuring what matters: a call for balance and parsimony

  1. Gordon C Hunt9
  1. 1Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  2. 2Ascension Health, St Louis, Missouri, USA
  3. 3Intermountain Healthcare, Salt Lake City, Utah, USA
  4. 4Mayo Clinic, Rochester, Minnesota, USA
  5. 5Virginia Mason Health System, Seattle, Washington, USA
  6. 6Quality and Care Delivery Excellence, Kaiser Permanente, Oakland, California, USA
  7. 7Institute for Healthcare Improvement, Boston, Massachusetts, USA
  8. 8Sentara Healthcare, Norfolk, Virginia, USA
  9. 9Sutter Health, Sacramento, California, USA
  1. Correspondence to Gregg S Meyer, MD, MSc Chief Clinical Officer and Executive Vice President for Population Health Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH 03756, USA;gregg.s.meyer{at}
  1. Competing interests None.

  • Accepted 29 June 2012
  • Published Online First 14 August 2012


External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs.


  • Provenance and peer review Not commissioned; internally peer reviewed.

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