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Significant private and public resources go into the production of various types of performance measures: from patient satisfaction with nonclinical service to clinical outcomes. While recent investigations have focused on the effect of clinical outcomes information on clinical practice, almost no work examines its effect on purchasers' decisions. This study examines how large employers use performance information, including clinical outcomes, in purchasing decisions. Representatives of thirty-three large employers that purchase for 1.8 million covered lives were interviewed in early 1997. Findings suggest that purchasers are not always aware of clinical outcomes data and that measures do not meet their decision-making needs. Further, the variety and amount of performance information to process for purchasing decisions is a barrier to effective decision making. Recommendations for supporting purchasers' use of performance information, especially clinical outcomes data, are included.

Policy makers, payers, and the general public are increasingly focused on health care quality improvement. Measuring quality requires robust data systems that collect data over time, can be integrated with other systems, and can be analyzed easily for trends. The goal of this project was to study effective tools and strategies in the design and use of clinical registries with the potential to facilitate quality improvement, value-based purchasing, and public reporting on the quality of care. The research team worked with an expert panel to define characteristics of effectiveness, and studied examples of effective registries in cancer, cardiovascular care, maternity, and joint replacement. The research team found that effective registries were successful in 1 or more of 6 key areas: data standardization, transparency, accuracy/completeness of data, participation by providers, financial sustainability, and/or providing feedback to providers. The findings from this work can assist registry designers, sponsors, and researchers in implementing strategies to increase the use of clinical registries to improve patient care and outcomes.

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In these difficult times, health care institutions need leaders, not simply managers. Leaders' breadth of skills and perspective come from understanding the values involved in health care delivery; managers know the right way to do things, but leaders know which are the right things to do. Schools of public health are moving away from their potential contribution to leadership development in health services administration. The result is a lack of accountability to the community. Leadership skills and an examination of values should be part of health services administration programs in schools of public health, which should see their mission as helping to identify and train leaders, not simply technical specialists in management.

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