Abstract
Although the U.S. health care system is usually entered through the physician’s office, quality evaluation has tended to focus on the hospital setting. The DEMPAQ (Developing and Evaluating Methods to Promote Ambulatory Care Quality) project, which uses medical records information and Medicare claims to assess the quality of care given to Medicare beneficiaries in physicians’ offices, was initiated in 1990 and funded by the Health Care Financing Administration. The DEMPAQ performance measures were built based on three principles–quality review (versus utilization review), open and interactive performance measure development (versus a “black box” approach), and focus on patterns of practice (versus individual performance errors)–with feedback and education.