Patient-based quality measurement systems.

Continual improvement of health care can be accelerated and evaluated by the development of patient-based measurement systems. This article provides (1) design principles to guide the development of patient-based measurement systems; (2) a specific, yet flexible method for designing and testing patient-based measurement systems; and (3) real-world examples of patient-based systems that offer a glimpse of the future. These systems can provide direct measures of successes and failures, strengths and weaknesses, and improvements and declines in the provider's capacity to produce desired health outcomes at a cost that represents value.