Current Reviews in Musculoskeletal Medicine

, Volume 5, Issue 4, pp 265–273 | Cite as

Brief history of quality movement in US healthcare

  • Youssra Marjoua
  • Kevin J. BozicEmail author
Health Policy (AD Sharan, Section Editor)


The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future. Elements noted to be associated with successful healthcare quality improvement efforts include the presence of physician leadership, infrastructural support, and prioritization of healthcare quality within the culture of the organization. Issues that will require continued work include the development of a valid and reliable evidence base, accurate and replicable performance measurement and data collection methods, and development of a standard set of specialty specific performance metrics, with accurate provider attribution, risk adjustment and reporting mechanisms.


Quality Healthcare Musculoskeletal Orthopedics History Improvement Performance measurement Standards Reporting Reimbursement Cost Value Public Private Government Evidence-base Structure Process Outcome Monitoring and evaluation 



KJ Bozic: Paid consultant for Blue Cross Blue Shield Association, Integrated Healthcare Association, Pacific Business Group on Health; Y Marjoua: none.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Harvard Combined Orthopaedic Residency ProgramBostonUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA

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