Quality Measurement Is the Starting Point, Not the Destination

For decades, healthcare organizations have relied on quality measurement to assess performance. But according to Donald Casey, MD, MPH, MBA, MACP, FAHA, quality measurement should do far more than generate reports or satisfy regulatory requirements.

"Quality measurement is the starting point," said Dr. Casey. "It's not the endpoint."

Throughout his career as a physician, healthcare executive, and national quality leader, Dr. Casey has viewed measurement as a tool for learning. When used effectively, quality measures help healthcare organizations identify gaps in care, uncover opportunities for improvement, and achieve better outcomes for patients.

That philosophy is central to the work of Battelle’s Partnership for Quality Measurement® (PQM), a national organization that brings together patients, caregivers, clinicians, health systems, payers, employers, policymakers, and researchers to advance meaningful, evidence-based quality measurement.

As Technical Co-Chair of PQM's Endorsement and Maintenance Primary Prevention Committee, Dr. Casey helps evaluate and advance measures that can drive improvement across the healthcare system. In a recent conversation with IHI, he reflected on how quality measurement shaped his career, why transparency matters, and where the field is headed next.

From Measuring Care to Improving It

Early in his career as a general internist at Rush Presbyterian St. Luke's Medical Center (now Rush Medical Center) in Chicago, Dr. Casey’s practice was grounded in professional responsibility, collegial teamwork, and a wish to do what was best for his patients.

When the National Registry of Myocardial Infarction revealed significant gaps between evidence-based recommendations and the care many patients were receiving, he saw an opportunity.

"I began asking myself not only how I could care for individual patients, but how I could systematically improve healthcare delivery for entire populations."

He developed a quality improvement registry for patients with diabetes in an internal medicine residency practice. The data helped residents and faculty identify trends, improve adherence to clinical guidelines, and strengthen preventive care.

The experience transformed his perspective. What started as a way to improve care for his own patients became a career dedicated to improving healthcare at scale. It also taught him a lesson he still carries today: "Never declare victory with a single quality measure."

Why Quality Measurement Matters

At its best, quality measurement creates visibility. It helps healthcare organizations understand where they are succeeding, where they are falling short, and where patients may not be receiving the care they need.

Dr. Casey recalls working with a major teaching hospital while serving as Chief Medical Officer for a Medicare Quality Improvement Organization. Hospital leaders believed they were among the highest performers in the region.

The data suggested otherwise, flagging an opportunity for growth and improvement.
By studying the practices of top-performing hospitals and addressing gaps in their own processes, the organization improved rapidly and became the leading performer in a 62-hospital cohort within three months.

For Dr. Casey, the lesson remains clear: quality measures should not be viewed primarily as compliance requirements. Meaningful healthcare quality measures are tools for impactful, continuous learning, he explains.

When healthcare organizations embrace measurement as a pathway, they build transparency, strengthen trust, and create a culture focused on better outcomes.

The Future of Quality Measurement

Healthcare is entering a new era of measurement. Historically, many quality measures relied on retrospective administrative data that often arrived too late to support real-time improvement. Today, healthcare organizations have access to richer and more timely information through electronic health records, remote monitoring technologies, and patient-reported outcome measures. Dr. Casey believes these advances create an opportunity to fundamentally rethink how measurement supports care delivery.

As his colleague Harlan Krumholz, MD, has noted, the future lies in making quality information available when clinicians and patients need it most. "We've got to make information, including measurements of how we're doing, much more relevant at the point of care while the patient is in the room."

That shift requires innovation and a willingness to challenge longstanding assumptions. It also requires ongoing collaboration among stakeholders to determine what should be measured and how measures can support better decision-making.

For Dr. Casey, the future is not about collecting more data. It is about making measurement meaningful. Quality measures should help patients and clinicians make informed decisions, support continuous learning, and capture what matters throughout the care experience, he explains. As healthcare evolves through advances in artificial intelligence, personalized medicine, and digital health technologies, effective measurement will continue to play a critical role in identifying new pathways to better health.

"Quality measurement is not just a number on a scorecard, or a laborious regulatory requirement," Dr. Casey says. "Rather, its primary purpose is to promote lifelong learning and improvement, as well as to ensure that every patient always receives the best care possible."

Donald E. Casey, Jr., MD, MPH, MBA, MACP, FAHA is a board certified general internist, physician executive and healthcare quality leader who has spent more than three decades improving patient outcomes through quality measurement, physician engagement, and value-based care. As founder of IPO 4 Health, he advises major healthcare organizations and federal agencies. Dr. Casey is the Technical Co-Chair for the Partnership for Quality Measurement’s Endorsement and Maintenance (E&M) Primary Prevention Committee. 

Kaely Burgess is a Project Manager, Amy Minichino is a Project Manager, and Tara Bristol Rouse is a Senior Project Director at IHI.

Interested in Learning More or Getting Involved with Battelle and its PQM?

Battelle is a CMS-certified consensus-based entity and administers the Partnership for Quality Measurement® (PQM), a national forum that brings together patients, caregivers, clinicians, health systems, payers, employers, researchers, and policymakers to evaluate and advance healthcare quality measures. Through a transparent, evidence-based process, PQM helps ensure that measures improve care and outcomes while minimizing unnecessary reporting burden.

• Become a PQM member to receive updates and engagement opportunities throughout the year
• Submit public comments on proposed measures, process enhancements, committee rosters, and recommendations

All committee and membership opportunities are free of charge. Questions? Contact PQM at PQMSupport@battelle.org

Photo by Eilis Garvey on Unsplash

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• Connections Between Quality Measurement and Improvement
• Getting Involved with the Partnership for Quality Measurement: A Beginner’s Guide