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Measure Conceptualization

Justify the Creation of New Measures

If no existing measures are suitable for adoption or respecification (see the Measure Harmonization content), then the measure developer may develop a new measure. They must justify the new measure by gathering supporting information, which will vary by type of measure, and which will contribute to the business case.

The goal is to develop a measure most proximal to the outcome desired. Measure developers should avoid selecting or constructing a measure the measured entity can meet primarily through documentation—often satisfied with a checkbox, date, or code—for example, completing an assessment, care plan, or delivered instructions—without evaluating the quality of the activity. 

Justification Guidelines

Measure developers should consider these guidelines in their justification of a new measure.

Type of MeasureGuideline
Outcome MeasureThere should be a rationale supporting the relationship of the health outcome to processes or structures of care. Specifically, there must be at least one health care-related structure, process, service, or intervention that can improve performance on the outcome.
Intermediate Outcome MeasureThere should be a body of evidence the measured intermediate outcome leads to a desired health outcome.
Process MeasureThere should be a body of evidence linking the measured process to a desired health outcome.
Structure MeasureProvide evidence there is a connection from specific structural elements to improved care and improved health outcomes.
Cost and Resource Use MeasureLink with measures of quality care for the same topic.
Composite MeasureProvide the conceptual rationale.
All Measure Types

Ensure the unit of analysis aligns with an appropriate accountable entity (e.g., payor, hospital, or clinician).

Consider the extent to which processes are under the control of the measured entity. Attribute the measure topic to an appropriate provider or setting. In some cases, there is “shared accountability.” For example, for measures of functional outcomes and care coordination, no single provider controls performance results so the unit of analysis may be at the Accountable Care Organization- or payor-level rather than at the clinician-level.

Apply Measure Evaluation Criteria

If the measure developer identifies many measures or concepts, they should narrow the list of potential measures by applying measure evaluation criteria—especially the importance and feasibility criteria—to determine which measures should move forward. 

At a minimum, they should consider 

  • The measure’s relevance to the population
  • Effects on health care costs
  • Gaps in care
  • Availability of well-established evidence-based clinical guidelines
  • Translating supporting empirical evidence into meaningful quality measures 

The measure developer should explore possible data sources while considering feasibility (e.g., understanding the data captured in electronic health records) and include other criteria depending on the specific circumstances of the measure or measure set

Prepare an Initial List of Measures or Measure Topics

The measure developer should create an initial list of measures based on results of the previous activities. The measure developer then provides recommendations based on results of the environmental scan, measure gap analysis, initial feasibility assessment, and other information collected during the information gathering process. This list may contain adopted measures, respecified measures, new measures, or measure concepts. 

Before proposing a new measure, the measure developer should evaluate the literature for quality, quantity, and consistency. The measure developer then reviews the appropriateness of any clinical guidelines used as the basis for the measure to make sure the measure is based on a key leverage point and explores possible data sources for the new measure.

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