The document discusses access, cost, and quality in healthcare environments and recent quality initiatives. It addresses the relationship between quality measures and the role of advanced practice nurses (APNs). Quality measures are used to evaluate healthcare structures and processes and inform stakeholders about performance. APNs must be aware of quality standards and metrics to properly evaluate outcomes and deliver cost-effective, high-quality care. Without effective quality measures, the role of the APN may need to change to ensure adequate access, affordable costs, and good quality of care.