The escalating cost of health care and the increasing number of older adults make it necessary to focus on effectiveness/efficiency of care. Quality measures can help providers identify areas in which improved processes may lead to better outcomes. Quality assurance and performance improvement) involve collecting and analyzing data to facilitate meaningful conclusions and action plans for improvement. Performance improvement to optimize outcomes in the skilled nursing facility for community discharge, improvement in or maintenance of function, and avoiding hospital readmissions requires a team approach. A background for these quality measures and principles for an effective team response is presented.