Rating the Raters

The Inconsistent Quality of Health Care Performance Measurement

Published in: Annals of Surgery, 2016

Posted on RAND.org on January 22, 2016

by David M. Shahian, Sharon-Lise T. Normand, Mark W. Friedberg, Matthew M. Hutter, Peter J. Pronovost

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This article was published outside of RAND. The full text of the article can be found at the link above.

Research Question

  1. How can performance measurement in health care become more consistent?

Flawed measures are not only meaningless but may actually harm patients, providers, and other stakeholders. The measurement enterprise must be held to the same high standards that we appropriately expect of health care providers.


  • Because measuring health outcomes is complex and there are few widely accepted and enforceable standards, many flawed or inconsistent rating methodologies are now in use. Developing nationally recognized measurement standards, akin to those in other professions (such as finance) would help address this problem.
  • Professional societies and other measure developers should use the best available data and methodologies to develop valid performance measures and address gaps where measures are needed.
  • Rigorous peer review and complete transparency would help experts to critique the research methodology, results, and conclusions.
  • Submitting measures to the National Quality Forum a multi-stakeholder private-public partnership would provide an opportunity for vetting and endorsement of measures by a body of experts outside government.

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