Policy maker efforts to evaluate the quality and costs of health care have stimulated a proliferation of disparate performance measures. This cacophony of performance measures creates confusion over which measures are applicable at which level of the health care system, limiting their effective application for accountability and improvements in patient care. The American College of Physicians (ACP) has created a clinical performance measurement framework to provide direction to policy makers and measure developers for future performance measure development and application. The ACP believes that this clinical performance measurement framework is one way to help promote transformational change in patient care through judicious application of performance measures. Recommendation. The ACP recommends that policy makers and measure developers adopt this clinical performance measurement framework to promote transformational change and improve the quality of health care in the United States.