Policy Support For Patient- Centered Care: The Need For Measurable Improvements In Decision Quality Documenting gaps in patients' knowledge could stimulate rapid change, moving decisions and care closer to a patient-centered ideal

The phenomenon of practice variation draws attention to the need for better management of clinical decision making as a means of ensuring quality. Different policies to address variations, including guidelines and measures of appropriateness, have had lit- tle demonstrable impact on variation itself or on the underlying quality problems. Variations in rates of interventions raise questions about the patient-centeredness of decisions that determine what care is provided to whom. Policies that support the development and rou- tine use of measures of decision quality will provide opportunities to measurably improve the quality of decisions, thereby leading to more patient-centered and efficient health care.