Intended for healthcare professionals

Analysis Measuring quality through performance

Future of quality measurement

BMJ 2007; 335 doi: (Published 29 November 2007) Cite this as: BMJ 2007;335:1130
  1. Helen Lester, professor of primary care,
  2. Martin Roland, director
  1. National Primary Care Research and Development Centre, Manchester M13 9PL
  1. Correspondence to: H Lester helen.lester{at}

    General practitioners have responded well to current UK performance targets. Helen Lester and Martin Roland examine the options for keeping up the progress

    In the past decade there has been sustained international interest in measuring quality of care. In the United Kingdom, quality indicators with financial incentives to reward good care were introduced as a result of increasing awareness of variable quality in primary care, the technical feasibility of introducing evidence based indicators within information technology systems, and a resolve by political negotiators to use improved quality to secure additional investment in primary care.1 Similar but less comprehensive initiatives have been introduced in the United States, Europe, Australia, and New Zealand. However, as this series has shown, the use of quality measures has also created controversy. Our view is that using incentives to improve quality of care has been beneficial. We look at what needs to be done to ensure those benefits remain in the future.

    Options for developing quality measures

    The quality and outcomes framework, which forms the basis of quality measurement in UK primary care, could be developed in several different ways:

    • Leave indicators unchanged and expect higher achievement each year—This means restricting the potential benefits of quality measures to a limited number of areas2

    • Add new indicators or conditions regularly—This could lead to a vast and unmanageable set of measures

    • Build a larger set of evidence based measures that are all monitored and pay for performance against a subset of these

    • Remove measures once a predetermined and agreed level of achievement has been reached—Although this would allow new …

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