2559 lines
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2559 lines
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<span>Measure Development Principles</span>
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<span><strong>Blueprint Measure Lifecycle</strong></span>
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/conduct-environment-scan">
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<span>Conduct an Environmental Scan</span>
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/analyze-data-gap-analysis">
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<span>Analyze Data & Conduct Gap Analysis</span>
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/respecified-measures">
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<span>Respecified Measures</span>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/justify-creation-new-measures">
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<span>Justify the Creation of New Measures</span>
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</a>
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</li>
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</ul>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Business Case Development</span>
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</button>
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<ul id="basic-nav-section-Business-Case-Development" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Business-Case-Development" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/business-case/overview">
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<span>Overview</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/business-case/outcomes">
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<span>Documenting Outcomes, Benefits, & Costs</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/business-case/best-practices">
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<span>Business Case Best Practices</span>
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</a>
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</li>
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</ul>
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</li>
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</ul>
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</div>
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<div class="desktop:grid-col-3">
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<div class="usa-nav__headermenu-item">
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<span><strong>Measure Specification</strong></span>
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</div>
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<ul id="basic-nav-section-Measure-Specification" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Measure-Specification" >
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<a href="/measure-lifecycle/measure-specification/overview">
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<span>Overview</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/specifications-measure-category">
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<span>Specifications by Measure Category</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/define-data-sources">
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<span>Define Data Sources</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<button id="usa-accordion__button_second-3 usa-nav__submenu-list-2" class="usa-accordion__button_second usa-nav__link is_expanded closed" aria-expanded="false" aria-controls="basic-nav-section-Measure-Specification">
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<span>Develop Specifications</span>
|
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</button>
|
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<ul id="basic-nav-section-Develop-Specifications" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Develop-Specifications" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/overview">
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<span>Overview</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/target-initial-population">
|
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<span>Define the Target/Initial Population</span>
|
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</a>
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/develop-specification/denominator">
|
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<span>Define the Denominator</span>
|
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</a>
|
|
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|
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</li>
|
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/develop-specification/numerator">
|
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<span>Define the Numerator and Exclusions</span>
|
|
</a>
|
|
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|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/develop-specification/stratification">
|
|
<span>Define Stratification Scheme</span>
|
|
</a>
|
|
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|
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</li>
|
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
|
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|
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<a href="/measure-lifecycle/measure-specification/develop-specification/respecifying-registry-measures">
|
|
<span>Respecifying Registry Measures to Electronic Clinical Quality Measures (eCQMs)</span>
|
|
</a>
|
|
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|
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</li>
|
|
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|
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</ul>
|
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<button id="usa-accordion__button_second-3 usa-nav__submenu-list-2" class="usa-accordion__button_second usa-nav__link is_expanded closed" aria-expanded="false" aria-controls="basic-nav-section-Measure-Specification">
|
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<span>Specify the Code</span>
|
|
</button>
|
|
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|
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<ul id="basic-nav-section-Specify-the-Code" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Specify-the-Code" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/specify-code/overview">
|
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<span>Overview</span>
|
|
</a>
|
|
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|
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</li>
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/specify-code/code-systems-vocabularies-terminologies">
|
|
<span>Code Systems, Vocabularies, and Terminologies</span>
|
|
</a>
|
|
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|
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</li>
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/specify-code/encode-clinical-information">
|
|
<span>Encoding Clinical Information</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/specify-code/data-standards">
|
|
<span>Data Standards</span>
|
|
</a>
|
|
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|
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</li>
|
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|
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</ul>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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|
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<span>Construct Data Protocol</span>
|
|
</button>
|
|
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|
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|
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<ul id="basic-nav-section-Construct-Data-Protocol" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Construct-Data-Protocol" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/data-protocol/overview">
|
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<span>Overview</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/key-terms">
|
|
<span>Define Key Terms, Data Elements, Codes, and Code Systems</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/level-measurement-analysis">
|
|
<span>Describe Level of Measurement & Sampling</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/risk-adjustment">
|
|
<span>Determine Risk Adjustment</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/time-interval">
|
|
<span>Define Any Time Intervals</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
|
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|
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/scoring">
|
|
<span>Describe Scoring & Calculation Algorithm</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
|
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|
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</ul>
|
|
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</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
|
|
|
|
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|
|
<a href="/measure-lifecycle/measure-specification/document-measure">
|
|
<span>Document the Measures</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
|
|
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|
|
<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Measure Harmonization</span>
|
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</button>
|
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<ul id="basic-nav-section-Measure-Harmonization" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Measure-Harmonization" >
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/overview">
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<span>Overview</span>
|
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</a>
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/alignment">
|
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<span>Measure Harmonization and Alignment</span>
|
|
</a>
|
|
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|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/when-to-consider">
|
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<span>When to Consider Measure Harmonization</span>
|
|
</a>
|
|
|
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</li>
|
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</ul>
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</li>
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</ul>
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</div>
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<div class="desktop:grid-col-3">
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<div class="usa-nav__headermenu-item">
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<span><strong>Measure Testing</strong></span>
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</div>
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<a href="/measure-lifecycle/measure-testing/overview">
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<span>Overview</span>
|
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</a>
|
|
|
|
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Measure Testing Process</span>
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</button>
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<ul id="basic-nav-section-Measure-Testing-Process" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Measure-Testing-Process" >
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<a href="/measure-lifecycle/measure-testing/process/overview">
|
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<span>Overview</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
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|
|
|
|
<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-testing/process/develop-workplan">
|
|
<span>Develop The Testing Work Plan</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-testing/process/perform-sampl">
|
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<span>Perform Sampling</span>
|
|
</a>
|
|
|
|
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/process/implement-and-analyze">
|
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<span>Implement, Analyze, Refine & Retest</span>
|
|
</a>
|
|
|
|
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-testing/process/summary">
|
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<span>Measure Testing Summary</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-testing/process/testing-respecified-measures">
|
|
<span>Testing Respecified Measures</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
|
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|
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</ul>
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Measure Evaluation Criteria</span>
|
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</button>
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<ul id="basic-nav-section-Measure-Evaluation-Criteria" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Measure-Evaluation-Criteria" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/overview">
|
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<span>Overview</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/importance">
|
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<span>Importance</span>
|
|
</a>
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/scientific-acceptability">
|
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<span>Scientific Acceptability</span>
|
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</a>
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/feasibility">
|
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<span>Feasibility</span>
|
|
</a>
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/usability">
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<div class="views-row"><div class="views-field views-field-field-parent-title"><h1 class="field-content"><span class="glossify-exclude">Measure <abbr tabindex="0" title="<p><span class="glossify-exclude">Specifications</span> are measure instructions addressing data elements, data sources, point of data collection, timing and frequency of data collection and reporting, specific instruments used (if appropriate), and implementation strategies.</p> " class="glossify-tooltip-tip" lang="en">Specification</abbr></span></h1></div></div>
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<h1 class="margin-0">
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<span property="schema:name">Define Key Terms, Data Elements, Codes, and Code Systems</span>
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<div property="schema:text" class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Measure developers must precisely define terms used in the <abbr tabindex="0" title="<p>The <span class="glossify-exclude">numerator</span> is the upper portion of a fraction used to calculate a rate, proportion, or ratio. Also called the measure focus, it is the target process, condition, event, or outcome. <span class="glossify-exclude">Numerator</span> criteria are the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator. A <span class="glossify-exclude">numerator</span> statement describes the action satisfying the conditions of the performance measure.</p> " class="glossify-tooltip-tip" lang="en">numerator</abbr> or <abbr tabindex="0" title="<p>The <span class="glossify-exclude">denominator</span> is a statement describing the population evaluated by the performance measure and is the lower part of a fraction used to calculate a rate, proportion, or ratio. It can be the same as the target/initial population or a subset of the target/initial population to further constrain the population for the purpose of the measure. CV measures may refer to this as measure population.</p> " class="glossify-tooltip-tip" lang="en">denominator</abbr> statement, or in allowable denominator exclusions, numerator exclusions, and denominator exceptions. The measure developer should include enough detailed information in the denominator, numerator, denominator exclusions, numerator exclusions, and denominator exceptions so that each person collecting data for the measure will interpret <abbr tabindex="0" title="<p><span class="glossify-exclude">Specifications</span> are measure instructions addressing data elements, data sources, point of data collection, timing and frequency of data collection and reporting, specific instruments used (if appropriate), and implementation strategies.</p> " class="glossify-tooltip-tip" lang="en">specifications</abbr> in the same way.</p>
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<p>If the measure developer is allowing multiple data collection methods, they should produce detailed specifications for each method. Measure developers construct some measures by using precisely defined components or discrete pieces of data, often called <abbr tabindex="0" title="<p>A data element is a basic unit of information with a unique meaning and subcategories (data items) of distinct value. National Institute of Standards and Technology. (n.d.). <em>Data element</em>. Computer Security Resource Center. Retrieved November 1, 2023, from&nbsp;<a href="https://csrc.nist.gov/glossary/term/data_element">https://csrc.nist.gov/glossary/term/data_element</a></p> " class="glossify-tooltip-tip" lang="en">data elements</abbr>. Technical specifications include the “how” and “where” to collect the required data elements. The measure developer should fully specify measures, including all applicable definitions and codes. For more information see the <a href="/measure-lifecycle/measure-specification/specify-code/overview">Specify the Code</a> section. Precise specifications are essential for successful implementation.</p>
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<p><strong>Example</strong></p>
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<ul>
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<li>Up-to-date vaccination status requires a clear definition of which type of vaccinations need assessment along with the definition of “up-to-date.”</li>
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</ul>
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<p>Patient <abbr tabindex="0" title="<p>The medical record is data obtained from the records or documentation maintained on a patient in any health care setting (e.g., hospital, home care, long term care, practitioner office). Includes electronic and paper medical record systems.</p> " class="glossify-tooltip-tip" lang="en">medical record</abbr> data from <abbr tabindex="0" title="<p>The <span class="glossify-exclude">electronic health record</span> is also known as the electronic patient record, electronic medical record, or computerized patient record. As defined by the International Social Security Association, an <span class="glossify-exclude">EHR</span> is a “longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, diagnoses and treatment, medications, allergies, immunizations as well as radiology images and laboratory results.” International Social Security Association. (n.d.). <em>Information and communication technology - Guideline 91. electronic health record system</em>. Retrieved November 1, 2023, from&nbsp;<a href="https://ww1.issa.int/guidelines/ict/180156">https://ww1.issa.int/guidelines/ict/180156</a></p> " class="glossify-tooltip-tip" lang="en">electronic health records</abbr> (EHRs) and other clinical systems (for example, <abbr tabindex="0" title="<p>An electronic clinical quality measure (eCQM) is a measure specified in a standard electronic format that uses data electronically extracted from electronic health records and/or health information technology systems to measure the quality of health care provided. Electronic Clinical Quality Improvement Resource Center. (n.d.) <em>Glossary</em>. Retrieved May 22, 2024, from&nbsp;https://ecqi.healthit.gov/glossary</p>" class="glossify-tooltip-tip" lang="en">electronic clinical quality measures</abbr> [eCQMs]) or measures specified for use in an EHR and other electronic clinical systems) consist of patient-level information coded in such a way for extraction in a format for measure calculation. Information entered in an EHR and other electronic clinical systems, but not coded in a structured field, may require special processing by measure implementers.</p>
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<p>Patient medical record data from paper charts, EHRs, and other electronic clinical systems (if not specified for an EHR) require instructions for abstraction. It is important to specify which value when there will be multiple values in a record, e.g., average of all lab values in a year, only the most recent lab value, or the first lab value during a hospitalization. The level of detail may require specifying allowable terms, allowable places in the record, and the allowable values. The measure developer should assess inter-rater <abbr tabindex="0" title="<p><span class="glossify-exclude">Reliability</span> reflects the measure is well defined and precisely specified so measured entities can implement consistently within and across organizations and that it distinguishes differences in performance.</p> " class="glossify-tooltip-tip" lang="en">reliability</abbr> to ensure the specifications are clear and unambiguous, see <a data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="2a3dabd6-c193-4f36-a551-eac339cbd714" href="/measure-lifecycle/measure-testing/evaluation-criteria/scientific-acceptability/reliability" title="Reliability">Reliability</a>.</p>
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<p><strong>Examples</strong></p>
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<ul>
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<li>Allowable terms used from the record: hypertension; HTN; high blood pressure; ↑BP</li>
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<li>Allowable places within the record: problem list, history and physical, and progress notes</li>
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<li>Allowable values: systolic blood pressure <130, urine dipstick result +1 or greater.</li>
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</ul>
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<p>Claims data require information regarding type of claim, data fields, code types, and lists of codes.</p>
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<p><strong>Example</strong></p>
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<ul>
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<li>The Acute Myocardial Infarction (AMI) <abbr tabindex="0" title="<p><span class="glossify-exclude">Mortality</span> is the number of deaths in a given time or place, the proportion of deaths to population. “Death rate” is also called “<span class="glossify-exclude">mortality</span> rate.”</p> " class="glossify-tooltip-tip" lang="en">mortality</abbr> measure includes admissions for Medicare fee for service beneficiaries aged ≥65 years discharged from non-federal acute care hospitals having a principal discharge diagnosis of AMI and with a complete claims history for the 12 months prior to the date of admission. The codes International Classification of Diseases - 10th Revision- Clinical Modification code I21.xx, excluding those with I22.xx (AMI, subsequent episode of care).</li>
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<div class="views-row"><span class="views-field views-field-changed"><strong class="views-label views-label-changed">Last Updated: </strong><span class="field-content"><time datetime="2023-05-08T14:19:58-04:00">May 2023</time>
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