Clinical quality initiatives: the search for meaningful--and accurate--measures.

At times, it seems as though every hospital, hospital association, philanthropic foundation and major corporation in the United States is involved in the quality movement in health care. The explosion of quality measurement initiatives that began in the 1980s is continuing apace, with earlier programs being expanded, enhanced, modified and replicated throughout the country in a variety of settings. This cover story looks at the broad efforts to develop clinical quality measurement tools from four different perspectives. First, we provide an update on the Maryland Quality Indicator Project and its ongoing use as a role model for many of the newer clinical indicator projects now being developed. Part two looks at the Joint Commission on Accreditation of Healthcare Organizations and its Agenda for Change project, as well as other large-scale quality measurement programs under way in the private sector that are attempting to determine what indicators are meaningful to use. Part three examines the growing role of corporate payers in pushing hospital-comparison and other assessment programs forward. And in the final section, we look at the federal government's role in developing practice guidelines and outcomes research.