It is well established that many US patients receive suboptimal care and that subgroups disadvantaged on the basis of demographic or socioeconomic characteristics are at special risk.1,2 Even among advantaged patients, the quality of US health care has been shown to lag well below national goals.3,4 In the landmark Community Quality Index study, McGlynn et al3 and Kerr et al5 documented not only that quality of care is suboptimal, but that quality problems are not limited to a specific set of conditions or communities.