Measure developers often risk adjust and/or stratify outcome measures and cost and resource use measures, however not all outcome measures need risk adjustment or risk stratification. For outcome measures, the measure developer should use beta testing to evaluate an evidence-based risk adjustment strategy. Typically, process measures do not need risk adjustment because the measured processes are appropriate for all patients included in the denominator and the measure excludes all the patients for whom the measure is not appropriate.

The measure developer must provide empirical evidence for adequacy of the risk adjustment or a rationale that risk adjustment is not necessary to ensure fair comparisons.

Measure developer-provided information should include the analytic methods used and evidence of meaningful differences. If using stratification, the measure developer should include stratification results. Additional information about risk adjustment, stratification, and social factors is available in the Risk Adjustment for Quality Measurement supplemental material.