The advent of federal initiatives to regulate the cost of
health care has spawned efforts to measure the quality of such care.
The implementation of Diagnostic Related Groups, the Omnibus Budget
Reconciliation Act, and the use of outcomes research represent a
process that has evolved from initial attempts to reduce cost to
evaluations of the effectiveness of various health-care procedures and
programs. The cooperative effort among physicians, providers, and
payers that became the Cleveland Health Quality Choice (CHQC) project
has been part of this evolution. Its purpose is to identify health-care
institutions that provide quality health care so that insurers and
patients can make informed decisions about medical care. Community-wide
publication of evaluation results is an integral part of this effort.
As such, the study by Sirio and colleagues in this issue of
CHEST (see page 793) presents a notable analysis in this