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<span>Documenting Outcomes, Benefits, &amp; Costs</span>
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<a href="/measure-lifecycle/measure-specification/define-data-sources">
<span>Define Data Sources</span>
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<span>Overview</span>
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<a href="/measure-lifecycle/measure-specification/develop-specification/target-initial-population">
<span>Define the Target/Initial Population</span>
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<a href="/measure-lifecycle/measure-specification/develop-specification/denominator">
<span>Define the Denominator</span>
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<a href="/measure-lifecycle/measure-specification/develop-specification/numerator">
<span>Define the Numerator and Exclusions</span>
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<a href="/measure-lifecycle/measure-specification/develop-specification/stratification">
<span>Define Stratification Scheme</span>
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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>
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<a href="/measure-lifecycle/measure-specification/specify-code/code-systems-vocabularies-terminologies">
<span>Code Systems, Vocabularies, and Terminologies</span>
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<span>Encoding Clinical Information</span>
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<a href="/measure-lifecycle/measure-specification/specify-code/data-standards">
<span>Data Standards</span>
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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>
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<a href="/measure-lifecycle/measure-specification/data-protocol/level-measurement-analysis">
<span>Describe Level of Measurement &amp; Sampling</span>
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<a href="/measure-lifecycle/measure-specification/data-protocol/risk-adjustment">
<span>Determine Risk Adjustment</span>
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<a href="/measure-lifecycle/measure-specification/data-protocol/time-interval">
<span>Define Any Time Intervals</span>
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<a href="/measure-lifecycle/measure-specification/data-protocol/scoring">
<span>Describe Scoring &amp; Calculation Algorithm</span>
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<a href="/measure-lifecycle/measure-specification/document-measure">
<span>Document the Measures</span>
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<span>Measure Harmonization</span>
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<span>Overview</span>
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/alignment">
<span>Measure Harmonization and Alignment</span>
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/when-to-consider">
<span>When to Consider Measure Harmonization</span>
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<span><strong>Measure Testing</strong></span>
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<span>Overview</span>
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<span>Measure Testing Process</span>
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<span>Overview</span>
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<span>Develop The Testing Work Plan</span>
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<span>Perform Sampling</span>
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<span>Implement, Analyze, Refine &amp; Retest</span>
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<a href="/measure-lifecycle/measure-testing/process/summary">
<span>Measure Testing Summary</span>
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<a href="/measure-lifecycle/measure-testing/process/testing-respecified-measures">
<span>Testing Respecified Measures</span>
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<span>Overview</span>
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<span>Importance</span>
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<span>Scientific Acceptability</span>
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<span>Feasibility</span>
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<span>Usability &amp; Use</span>
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<span><strong>Measure Implementation</strong></span>
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<span>Overview</span>
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<span>Measure Selection</span>
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<span>Overview</span>
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<a href="/measure-lifecycle/measure-implementation/pre-rulemaking/guidance-measure-submitters">
<span>Guidance for Measure Submitters</span>
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<span>Measure Priorities</span>
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<span>MUC Lists and Recommendation Reports</span>
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<span>Measure Rollout</span>
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<span>CMS Consensus-Based Entity (CBE) Endorsement and Maintenance</span>
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<a href="/measure-lifecycle/measure-implementation/CMS-CBE-EM/overview">
<span>Overview</span>
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<a href="/measure-lifecycle/measure-implementation/CMS-CBE-EM/Measure-Submission-to-the-CMS-CBE">
<span>Measure Submission to the CMS CBE</span>
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<a href="/measure-lifecycle/measure-implementation/CMS-CBE-EM/Endorsement-Process">
<span>The CMS CBE Endorsement Process</span>
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<span><strong>Measure Use, Continuing Evaluation &amp; Maintenance</strong></span>
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<span>Measure Production &amp; Monitoring</span>
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<span>Continuing Evaluation</span>
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<span>Measure Maintenance Reviews</span>
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<span>Overview</span>
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<a href="/measure-lifecycle/measure-use/maintenance/annual-update">
<span>Annual Update</span>
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<a href="/measure-lifecycle/measure-use/maintenance/comprehensive-reevaluation">
<span>Comprehensive Reevaluation</span>
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<a href="/measure-lifecycle/measure-use/maintenance/early-maintenance-review">
<span>Early Maintenance Review</span>
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<a href="/measure-lifecycle/measure-use/maintenance/harmonization-during-maintenance">
<span>Harmonization during Measure Maintenance</span>
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<span><strong>Interested Party Engagement</strong></span>
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<span>Overview</span>
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<a href="/measure-lifecycle/stakeholder-engagement/lifecycle">
<span>Interested Party Engagement in the Measure Lifecycle</span>
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<a href="/measure-lifecycle/stakeholder-engagement/roles">
<span>Roles in Engagement</span>
</a>
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<a href="/measure-lifecycle/stakeholder-engagement/types">
<span>Types of Interested Party Engagement</span>
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<span>Tools &amp; Resources</span>
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<span><strong>MMS Tools &amp; Resources</strong></span>
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<a href="/tools-and-resources/mms-supplemental-materials">
<span>Supplemental Materials</span>
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<a href="/tools-and-resources/mms-templates">
<span>Templates for Measure Development</span>
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<span>Educational Resources</span>
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<span>MMS Tools</span>
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<span><strong>Additional Tools &amp; Resources</strong></span>
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<span>CMS Tools</span>
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<span>External Resources</span>
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<a href="https://mmshub.cms.gov/glossary">
<span>Glossary</span>
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<span><strong>Pre-Rulemaking Resources</strong></span>
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<a href="/Pre-Rulemaking-Resources">
<span>Pre-Rulemaking Resources</span>
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<span>Get Involved</span>
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<span><strong>Get Involved</strong></span>
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<a href="/get-involved/how-to">
<span>How to Get Involved</span>
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<span>Technical Expert Panels</span>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
<a href="/get-involved/technical-expert-panel/overview">
<span>Overview</span>
</a>
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<a href="/get-involved/technical-expert-panel/current">
<span>Current TEP Opportunities</span>
</a>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
<a href="/get-involved/technical-expert-panel/updates">
<span>Updates to Established TEPs</span>
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<span>Public Comments</span>
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<a href="/get-involved/public-comments/overview">
<span>Overview</span>
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<a href="/get-involved/public-comments/current">
<span>Current Public Comment Opportunities</span>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
<a href="/get-involved/public-comments/summaries">
<span>Summaries of Past Public Comments</span>
</a>
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<a href="/get-involved/call-for-measures">
<span>Call for Measures</span>
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<a href="/get-involved/other-involvement">
<span>Other Types of Involvement</span>
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<span><strong>News &amp; Events</strong></span>
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<span>News &amp; Events</span>
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<a href="/news-events/news-by-month">
<span>News By Month</span>
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<a href="/news-events/event-calendar">
<span>Event Calendar</span>
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<a href="/measure-lifecycle/measure-specification/overview" class="usa-breadcrumb__link"><span>Measure Specification</span></a>
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<a href="/measure-lifecycle/measure-specification/develop-specification/overview" class="usa-breadcrumb__link"><span>Develop Specifications</span></a>
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<span>Define Stratification Scheme</span>
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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="&lt;p&gt;&lt;span class=&quot;glossify-exclude&quot;&gt;Specifications&lt;/span&gt; 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.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">Specification</abbr></span></h1></div></div>
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<h1 class="margin-0">
<span property="schema:name">Define Stratification Scheme</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><span>Measure developers may define a <abbr tabindex="0" title="&lt;p&gt;&lt;span class=&quot;glossify-exclude&quot;&gt;Stratification&lt;/span&gt; divides a population or resource services into distinct, independent groups of similar data, enabling analysis of the specific subgroups. This type of adjustment can show where disparities exist or where there is a need to expose differences in results.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">stratification</abbr>&nbsp;scheme in lieu of <abbr tabindex="0" title="&lt;p&gt;&lt;span class=&quot;glossify-exclude&quot;&gt;Risk adjustment&lt;/span&gt; is a mathematical model applied to a quality measure correcting for differing characteristics within a population, such as patient health status. Its purpose is a fairer and more accurate comparison of outcomes of care across health care organizations or clinicians. Measure developers usually apply &lt;span class=&quot;glossify-exclude&quot;&gt;risk adjustment&lt;/span&gt; models to outcome and cost/resource use measures.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">risk adjustment</abbr>&nbsp;by stratifying the <abbr tabindex="0" title="&lt;p&gt;The &lt;span class=&quot;glossify-exclude&quot;&gt;population&lt;/span&gt; is the total group of people of interest for a quality measure, sometimes called the target/initial &lt;span class=&quot;glossify-exclude&quot;&gt;population&lt;/span&gt;. The measure &lt;span class=&quot;glossify-exclude&quot;&gt;population&lt;/span&gt; is a defined subset appropriate to the measure set not excluded from the individual measure.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">population</abbr>&nbsp;based on their risk for an outcome or procedure. They may also stratify according to a reporting scheme (e.g., if reported data are in strata by age groups). For more information, refer to the&nbsp;</span><a href="/media/13" data-entity-type="media" data-entity-uuid="4cc52d47-7585-4b21-a2ef-848bf1729d44" data-entity-substitution="media"><em><span>Risk Adjustment in Quality Measurement</span></em></a><em><span>&nbsp;</span></em><span>supplemental material, Table 1. Framework for Risk Adjustment Strategies.</span></p><p><span>Measure developers should always consider stratifying by sociodemographic characteristics. Stratification may effectively detect potential disparities in care/outcomes among populations related to the measure&nbsp;focus. If the measure developer stratifies results by population characteristics, then the measure developer must describe population stratification variables.</span></p><p><span>When the measure definition includes stratification, the measure developer reports each population in the measure definition both without stratification and by each stratification <abbr tabindex="0" title="&lt;p&gt;A criterion is an accepted standard, principle, or rule used to make a decision or to inform an evaluators judgment.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">criteria</abbr>. For measures with multiple <abbr tabindex="0" title="&lt;p&gt;The &lt;span class=&quot;glossify-exclude&quot;&gt;numerator&lt;/span&gt; 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. &lt;span class=&quot;glossify-exclude&quot;&gt;Numerator&lt;/span&gt; criteria are the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator. A &lt;span class=&quot;glossify-exclude&quot;&gt;numerator&lt;/span&gt; statement describes the action satisfying the conditions of the performance measure.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">numerators</abbr>&nbsp;and/or strata, they should consider <abbr tabindex="0" title="&lt;p&gt;&lt;span class=&quot;glossify-exclude&quot;&gt;Scoring&lt;/span&gt; is the method(s) applied to data to generate results/score. Most quality measures produce rates; however, other &lt;span class=&quot;glossify-exclude&quot;&gt;scoring&lt;/span&gt; methods include categorical value, CV, count, frequency distribution, non-weighted score/composite/scale, ratio, and weighted score/composite/scales.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">scoring</abbr>&nbsp;each patient/episode for inclusion/ <abbr tabindex="0" title="&lt;p&gt;The &lt;span class=&quot;glossify-exclude&quot;&gt;denominator&lt;/span&gt; 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.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">denominator</abbr> exclusion and/or numerator exclusion&nbsp;to every population. For example, if a&nbsp;measure has two numerators, and the patient is included in the first numerator, the patient should also be&nbsp;scored for inclusion/ denominator exclusion and/or numerator exclusion from the populations related to the other numerators e.g.,&nbsp;Antidepressant Medication Management (</span><a href="https://cmit.cms.gov/cmit/#/FamilyView/?familyId=63"><span>CMIT Member ID 63</span></a><span>)&nbsp;(<abbr tabindex="0" title="&lt;p&gt;The Medicare Improvements for Patients and Providers Act of 2008 requires the U.S. Department of Health and Human Services to contract with a consensus-based entity (CBE) regarding performance measurement. The CMS CBE endorses quality measures through a transparent, consensus-based process incorporating feedback from diverse groups of interested parties to foster health care quality improvement.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">CMS CBE</abbr> #0105)</span>.</p><p><span>Measure developers should stratify measures by organizational characteristics. This is known as peer group stratification, and it is appropriate in any circumstance when there is unmeasured systematic and persistent patient heterogeneity and characteristics of the organizational setting are related to that unmeasured patient heterogeneity (e.g., location). There should be an explicit hypothesis or rationale as to why the characteristic is related to the unmeasured patient heterogeneity, but not the </span><a href="/measure-lifecycle/measure-specification/data-protocol/overview" data-entity-type="node" data-entity-uuid="ed2d5f22-8b0f-43bb-b571-a05b21746770" data-entity-substitution="canonical" title="Construct Data Protocol"><span>quality construct</span></a><span>.</span></p><p><span>If there is a reporting requirement of multiple rates or stratifications, the measure developer should state this in the <abbr tabindex="0" title="&lt;p&gt;&lt;span class=&quot;glossify-exclude&quot;&gt;Specifications&lt;/span&gt; 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.&lt;/p&gt; " class="glossify-tooltip-tip" lang="en">specifications</abbr>. If the measure developer includes the allowable denominator and/or numerator exclusion in the numerator, they should specify the measure reports the overall rate as well as the rate of each denominator and/or numerator exclusion. If stratification of results is by population characteristics, they should describe the variables used.</span></p><p><span><strong>Examples</strong></span></p><p><span>Possible stratification schemes</span></p><ul><li><span>Vaccination measure numerator that includes (1) health care worker who received the vaccine; (2) health care worker who was offered the vaccine and declined; or (3) health care worker who has an allergy, a condition, or another medical contraindication to the vaccine, e.g., Influenza Vaccination Coverage Among Healthcare Personnel&nbsp;(</span><a href="https://cmit.cms.gov/cmit/#/FamilyView/?familyId=390"><span>CMIT Member&nbsp;ID 390</span></a><span>) (CMS CBE #0431)</span></li><li><span>Stratify the measure by a population type (i.e., race, ethnicity, age, social risk factors, income, region, gender, primary language, disability), e.g., Chlamydia Screening for Women&nbsp;(</span><a href="https://cmit.cms.gov/cmit/#/FamilyView/?familyId=128"><span>CMIT Measure&nbsp;ID 128</span></a><span>)&nbsp;(CMS CBE #0033)</span></li><li><span>For <abbr tabindex="0" title="&lt;p&gt;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.) &lt;em&gt;Glossary&lt;/em&gt;. Retrieved May 22, 2024, from&amp;nbsp;https://ecqi.healthit.gov/glossary&lt;/p&gt;" class="glossify-tooltip-tip" lang="en">electronic clinical quality measures</abbr>, include a Reporting Stratification section in the human-readable document. If&nbsp;a measure does not have reporting strata defined, the default display is “None.” If a measure contains reporting stratification, list each of the reporting strata separately under the Population&nbsp;Criteria section. For details, see the </span><a href="https://www.emeasuretool.cms.gov/madie-mvp"><span>Measure Authoring Development Integrated Environment (MADiE) User Guide</span></a><span>.</span></li></ul></div>
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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="2024-06-27T12:52:43-04:00">Jun 2024</time>
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