Abstract
In the 50 years since the American Board of Family Medicine (ABFM) was established, the United States has gone from a shared perspective that high-quality care was being routinely delivered to becoming aware of the significant and pervasive problems with quality. Efforts to stimulate improved quality have included public reporting, pay for performance, and value-based purchasing. In addition, maintenance of certification, systematic reviews of research, practice guidelines, electronic health records, and quality improvement programs have offered support for different dimensions of quality. Despite these programs and infrastructure, there is little evidence that quality has improved systematically in the United States. There are areas in which quality is better but many other areas in which quality has remained the same or even worsened. The focus on financial incentives as a primary tool for motivating improvement may not be productive and there is little evidence from research that quality varies with payment or incentives. Quality is a systems issue and requires system solutions. The ABFM has had a long commitment to assessing quality and has an opportunity to lead the way in reimagining quality measurement and assessment.
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