McCutcheon Jay C.; Schumacher, Dale N.Quality Management in Health Care: July 1994 LETTERS TO THE EDITOR: PDF Only Abstract The transformation of the health care delivery system in local, metropolitan, and regional markets is progressing rapidly. This transformation is fueled by competition, the shift of financial risk to the provider continuum, employer demands for cost containment, and the breadth and depth of state and federal government reform initiatives. However, information systems do not yet exist to support these transformations. We propose establishing a new community-level information management environment and new measures of health care system performance. ©1994Aspen Publishers, Inc.