If you don't know where you are going, you might not get there.

Hall-of-Fame baseball player Yogi Berra is well known for his witty quotes. Of his many yogiisms, a label for his humorous comments, Berra is credited with saying, “You’ve got to be very careful if you don’t know where you are going, because you might not get there. ” This statement may describe the journeys of healthcare organizations today. With so much activity in the healthcare landscape—the testing and implementation of multiple forms of payment and care delivery redesign programs—healthcare organizations must focus on “where we are going” and how to “get there. ” Although there are many unknowns in healthcare today, we know we all are moving toward a proliferation of new models of payment and care delivery, which are being tested in all sectors of the U.S. healthcare system. Accountable care organizations, patient-centered medical homes, and bundled payments are examples of programs and initiatives in the pilot phase. We have much to learn from the early implementation of these new models of both care redesign and payment redesign, before we get to the transformation in healthcare that we all seek. However, this activity requires strategy. To achieve a new level of performance in cost and quality in our healthcare system, program implementation must be done strategically with the end goal in mind—that is, knowing where we are going. We are “going” to a system that rewards high-quality and high-efficiency healthcare organizations. We are “going” to a system of coordinated care, with a focus on the health of populations and a swift, continuous drive to measurable, improved outcomes. We are “going” to a system that will reach new levels of performance through collaboration, evolutionary performance measurement, and health information connectivity. This Journal for Healthcare Quality (JHQ) special issue features a collection of eight peerreviewed articles that provide insights and learning on where we are headed and how to get there. The articles highlight quantitative and qualitative research findings of evolving quality measurement, care coordination programs, large-scale improvement efforts, and the implementation of multifaceted qualityimprovement interventions. Three articles, McDonald et al., Perla et al., and DuGoff et al., offer astute, applied research analysis in the development and use of quality measures for the future. McDonald et al. in “Can the Care Transitions Measure Predict Re-hospitalization Risk or Home Health Nursing Use of Home Healthcare Patients? ” test the applicability of the Care Transitions Measure (CTM) to the home health setting. Although the authors’ study did not find evidence that the CTM could predict patients at elevated risk for emergent care, rehospitalization, or high consumption of home health nurse resources, the focus on identifying effective, predictive measurement in transitional care is a fundamental building block for assessing and using services effectively in a future coordinated care system. Perla et al. in “Whole-Patient Measure of Safety: Using Administrative Data to Assess the Probability of Highly Undesirable Events During Hospitalization” review a new model that uses administrative data to measure hospitallevel safety of care. In their article, Perla et al. discuss identifying highly undesirable events to develop a Whole-Patient Measure of Safety. DuGoff et al. in “Setting Standards at the Forefront of Delivery System Reform: Aligning Care Coordination Quality Measures for Multiple Chronic Conditions” determine that quality measures currently used or proposed for three major new programs aiming to improve care coordination primarily address only one key area: continuity of care. Other key categories of care coordination—communication, care transitions, patient-centered care, and inclusion of measures that can apply to multiple conditions—were not as frequently captured by these major programs. In addition, there was little overlap in the quality measures used by these programs and the NQF care coordination measurement set. Two articles, Taylor et al. and Madan et al., discuss the positive impact of programs that emphasize care coordination for patient results. Taylor et al. in “Implementing a Care Coordination Program for Children with Journal for Healthcare Quality Vol. 35, No. 5, pp. 5–6