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Conceptualization


Overview of the Conceptualization Phase of Measure Development

In the conceptualization phase of measure development, the intent is to generate a list of concepts or ideas for measures that are meaningful and important to those who receive care and those who provide it. Conceptualization occurs continually throughout the measure lifecycle. It both starts the process as the first stage of formulating the idea for a measure, while also iteratively influencing the processes and outcomes of all the other phases in the measure management lifecycle (see figure below).

The evidence base for the measure concept and basic elements of the measure are generated in this phase during the information gathering step described below. The measure developer identifies whether any existing measures may be adapted or retooled to fit the desired purpose. If no existing measure matches the desired purpose, the measure developer works with a Technical Expert Panel (TEP) to develop a new measure. If the concept is perceived as filling a gap or of high importance, then it is further refined in the measure specification and measure testing stages.

Information gathering is the first step in conceptualization. Information gathering is a broad term that includes an environmental scan (literature review, clinical practice guidelines search, interviews, and other related activities) and empirical data analysis. These activities are conducted to obtain information that will guide the prioritization of topics or conditions. The information and data analysis also inform the measure specifications. Finally, these activities help develop the initial business case for why the potential improvement to healthcare quality outweighs the costs and effort to collect the data and compute the measure score. In the information gathering measure developers search for data related to:

  • Better Health
    • Incidence and prevalence of the condition in the population.
    • Disparities in population health.
    • Indirect costs from wages or salaries lost when ill.
  • Better Care
    • The major benefits of the process or intermediate outcome under consideration for the measure (e.g., heart attacks not occurring, hospital length of stay decreased) and the expected magnitude of the benefits.
    • Untoward effects of a process or intermediate outcome and the likelihood of their occurrence (e.g., bleeding from anticoagulation, death from low blood glucose levels).
    • Current process performance, intermediate outcomes, and performance gaps.
  • More Affordable Care
    • Cost of implementing the measures.
    • Cost of implementing the clinical processes.
    • Savings from preventing complications.
    • Savings from preventing unplanned readmissions.
    • Savings from improved health. 

A Technical Expert Panel (or TEP), composed of various subject matter experts and stakeholders, including persons and their families, is created and asked for input periodically throughout the measure lifecycle. The key to a strong TEP is diversity and it is especially critical to include the perspective of persons and their families. (Note that for electronic clinical quality measures (eCQMs), the TEP should include representation from electronic health records and Health IT vendors as well as coding experts.) During the conceptualization phase, the TEP may provide input on several related measure concepts during information gathering, examine harmonization efforts (i.e., did the environmental scan identify all similar measures in existence or under development) and evaluate the final concepts. Each proposed measure will be evaluated according to these four criteria

  • Importance to measure and report
  • Scientific acceptability
  • Feasibility
  • Usability and use

The last major component of this phase is to gather input from a wide variety of stakeholders through the public comment process. The process provides an avenue for potential issues to be identified early and prevents later rework. During this phase, comments are gathering during the information gathering step to assist in identifying concepts and following the TEP meeting to provide feedback on the meeting summaries. This process ensures that measures are developed:

  • Using a coherent and transparent process
  • Including the perspectives from the widest array of interested parties
  • Providing balanced input from relevant stakeholders and other interested parties
  • Receiving critical suggestions that may not have been previously considered by the measure contractor and/or the TEP

Resources:

CMS MMS Webinar BP101 – Measure Conceptualization

Measures Management Up Close: Conceptualization

Environmental Scan

CMS Blueprint (Section 3 – In-Depth Topics Environmental Scan)

CMS Blueprint (Section 3 – In-Depth Topics 7 Environmental Scan)

CMS MMS Webinar BP101 – Environmental Scanning

Business Case

CMS Blueprint (Section 2 – 1.2 Business Case Development)

CMS Blueprint Section 3 – In-Depth topics 8 Business Case)

Newsletter article on Business Case

Technical Expert Panels

CMS Blueprint (Section 3. In-Depth Topics – 9.2.1 Draft the TEP Charter)

CMS Blueprint (Section 3. In-Depth Topics 11.4.5 – summarize comments and produce report)

 

Tools:

CMS Blueprint (Section 5 – 1 Forms and Templates - Environmental Scan Outline)

CMS Blueprint Business Case Form Instructions and Template (Section 5 Forms and Templates)

CMS Blueprint TEP Charter Template

CMS Blueprint Technical Expert Panel (TEP) Nomination Form Template

CMS Blueprint (Section 3. In-Depth Topics 11.4 – Steps for Public Comment)

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