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Blueprint Measure Lifecycle

Measure Specification

This section provides an overview of how measure developers can create detailed, clear, rigorous, and precise specifications. Specifications are instructions for how to build and calculate a measure. The intent of measure specification is that each measure should reach its appropriate target/initial population, but not over-reach or under-reach. Errors in specifying the target/initial population not only waste resources, but also may generate misleading conclusions about care quality.

The measure specification stage consists of both specification and harmonization, along with stakeholder engagement through public comment and technical expert panels (TEPs). Final specifications provide comprehensive details that allow collection of measure data and implementation of the measure to be consistent, reliable, and effective.

Measure Lifecycle

Measure specification follows the conceptualization stage, when the measure developer identifies the initial intent of the measure based on clinical practice guidelines or a patient-reported outcome measure, and evidence identified in the environmental scanDevelopment of measure specifications is an iterative process throughout the Measure Lifecycle, with specifications informing and being informed by later stages of the measure development process, particularly measure testing.

Measure Specification & Measure Testing 

As a measure developer moves from alpha (formative) testing to beta (field) testing, the specification becomes more fully developed. As a result of testing, specifications continue to evolve, becoming more detailed and precise. 

  • For measures based on electronic, administrative, or claims-based data, the measure developer may provide draft specifications to the programming staff responsible for data retrieval and for developing programming logic necessary to produce the measure. Programmers will assess feasibility of the specifications as written and may provide feedback. 
  • For measures based on chart abstraction, the measure developer develops and tests data collection tools.
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  • Determine the measure ingredients and calculation formula
  • Collect input and testing findings on initial measure specifications to aid in refinement
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  • Includes annual update and comprehensive reevaluation every 3 years
  • Ad hoc review may be necessary
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  • Identify ideas or topics that are most important to stakeholders and address a gap in measurement
  • Scan the environment
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  • Collect qualitative and quantitative data to establish whether the measure meets evaluation criteria
  • Iterate with Measure Specification
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  • Pre- and rulemaking processes
  • Collect user input on initial measure specifications to aid in refinement
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Measure Specification Process

Developing specifications is an iterative process. When specifying a measure, the measure developer

  • Considers the data elements necessary for the proposed measure and conducts preliminary feasibility assessments.
  • May request preliminary input from standards subject matter experts (SMEs) regarding data model, terminology, data elements and content, Clinical Quality Language expression, and impact on clinician workflow.
  • Drafts initial specifications, which the TEP and possibly other stakeholders, such as work groups, SMEs, and other measure developers, will review and may suggest changes. Specifications at this stage likely include high-level numerator and denominator statements and initial information on potential denominator and numerator exclusions, if applicable.
  • Continues to detail specifications and refines them throughout the development process.

Specifications of special measure types may differ slightly in their execution. For more information about special measures, see the Resources.

Specification Details

Measure developers should specify measures with sufficient details to be distinguishable from other measures and to support consistent implementation. The CMS consensus-based entity Measure Evaluation Criteria and Guidance for Evaluating Measures for Endorsement notes measures should be specified with the broadest applicability (e.g., target/initial population, setting, level of measurement/analysis) as supported by the evidence.

  • The building blocks of a measure in the specifications may include, but not limited to 

    • Measure name/title
    • Measure description
    • Target/initial population
    • Numerator statement and definitions
    • Denominator statement and definitions
    • Denominator exclusions
    • Numerator exclusions
    • Denominator exceptions
    • Time interval
    • Stratification scheme, or how to split results to show differences across groups
    • Risk adjustment methodology
    • Calculation algorithm, or how to calculate results 
    • Sampling methodology
    • Data source(s)
    • Key terms, data elements, codes, and code systems
    • Level of analysis
    • Attribution model, or how to attribute data to measured entities
    • Care setting

Information Sources for Specifications 

Different information sources influence development of specifications for a measure. These inputs improve the precision of specifications and increase validity and reliability of the measure.

    • Literature review
    • Clinical practice guidelines
    • Clinical decision support artifacts
    • Existing measures
    • Stakeholder input, e.g., TEP, SME
    • Public comment
    • Alpha testing
    • Beta testing
Last Updated: Mar 2023