Quality Measure Guidelines
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According to the National Quality Measures Clearinghouse, a quality measure is a mechanism that enables users to quantify the quality of a selected aspect of care by comparing it to a criterion. Quality measure guidelines usually cite references from a research study whose findings were used to support the recommendations as noted in the guideline. Quality measure guidelines can be issued by governmental agencies, medical specialty society or professional organizations or by other sources such as a not-for-profit organization.
Quality Measure Guidelines – Governmental Agency
An example of a governmental agency that issues quality measure guidelines is the Centers for Medicare and Medicaid Services.
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Quality Measure Guidelines – Specialty Organizations
In addition to government agencies, medical specialty society or professional organizations that focus on a specific area of health care also produce quality measure guidelines. Medical specialty society guidelines are usually found on the website of the issuing organization but many are also noted in the National Quality Measures Clearinghouse database.
One example of a specialty organization that issues quality measure guidelines is the Physician Consortium for Performance Improvement (American Medical Association). The American Medical Association (AMA)-convened Physician Consortium for Performance Improvement (PCPI) is committed to enhancing quality of care and patient safety by taking the lead in the development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians.
Quality Measure Guidelines – Other
Guidelines are also produced by organizations not affiliated with a governmental or specialty organization. These guidelines are usually found on the website of the issuing organization but many are also noted in the National Quality Measures Clearinghouse database.
National Committee for Quality Assurance
The National Committee for Quality Assurance (NCQA), a nonprofit organization that sets voluntary coverage standards for healthcare organizations, uses the Health Plan Employer Data and Information Set (HEDIS) to measure health-plan performance. HEDIS is the most widely used “report card” system comparing health care plans across different dimensions of performance.
Development of a HEDIS measure includes conducting an extensive literature review of the proposed measure “to find supporting documentation of the importance, scientific soundness and feasibility.”
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Assessment
Review of quality measure guidelines is required to locate evidence that findings from a research study were used as support for implementation of a quality measure. Review of the literature can also be helpful in locating evidence of clinical implementation from research study findings noted in quality measure guidelines. For resources that may be helpful for review of the literature, see Knowledge Transfer: Mass Media and Knowledge Transfer: Reviews. Contact with policy-makers may be required in order to confirm that findings from a research study resulted in a quality measures guideline.
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Follow the directions as noted on the National Quality Measures Clearinghouse. |
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The following resource is also useful for locating quality measures guidelines:
National Quality Measures Clearinghouse
The National Quality Measures Clearinghouse (NQMC) mission is to provide practitioners, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining detailed information on quality measures, and to further their dissemination, implementation, and use in order to inform health care decisions. NQMC builds on AHRQ’s previous initiatives in quality measurement, including the Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST), the Expansion of Quality of Care Measures (Q-SPAN) project, the Quality Measurement Network (QMNet) project, and the Performance Measures Inventory (PMI).
Each domain of measurement in NQMC (i.e., Access, Outcome, Patient Experience, Process, and Structure) offers a different insight into health care quality:
- Access – an access measure assesses the patient’s attainment of timely and appropriate health care. Barriers to access may include inability to pay for health care, difficulty traveling to health care facilities, unavailability of health care facilities, lack of a “medical home,” cultural and health beliefs that prevent recognition of the need for and benefits of health care, and disparities in responding to persons seeking health care.
- Outcome – an outcome of care is a health state of a patient resulting from health care. An outcome measure can be used to assess quality of care to the extent that health care services influence the likelihood of desired health outcomes. Outcome-based measures of quality reflect the cumulative impact of multiple processes of care. Outcome measures may suggest specific areas of care that may require quality improvement, but further investigation is typically necessary to determine the specific structures or processes that should be changed.
- Patient Experience – a patient experience measure aggregates reports of patients about their observations of and participation in health care. These measures provide the patient perspective on quality of care.
- Process – a process measure assesses a health care service provided to, or on behalf of, a patient. Process measures are often used to assess adherence to recommendations for clinical practice based on evidence or consensus. To a greater extent than outcome measures, process measures can identify specific areas of care that may require improvement.
- Structure – a structure measure is a feature of a health care organization or clinician relevant to its capacity to provide health care. Structure data describe the capability of organizations or professionals rather than care provided to, or results achieved for, specific patients or groups of patients. For example, nurse/patient ratio is a structure-based measure because it does not describe care given to specific patients or specific groups of patients.
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Last updated: May 4, 2009