Measure Development by Phase
Quality Measure Development and Management Overview
Quality measures are tools that help measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care. CMS uses quality measures in its quality improvement, public reporting, and pay-for-reporting programs for specific healthcare providers. The end-product of measure development is a precisely specified, valid, reliable and clinically significant measure that is directly linked to the CMS quality goals.
The Centers for Medicare & Medicaid Services (CMS) manages a standardized approach (as documented in the Measures Management System Blueprint) for developing and maintaining such quality measures that are used in various quality initiatives and programs. This approach comprises a set of business processes and decision criteria that CMS-funded measure developers follow in the development, implementation, and maintenance of quality measures.
There are five phases in measure development:
- Conceptualization: Develop measure concepts and then narrow down to specific measures. The developer conducts an environmental scan and requests input from a broad group of stakeholders, including patients.
- Specification: Identify the population, the recommended practice, the expected outcome and determine how it will be measured.
- Testing: Assess the suitability of the quality measure’s technical specifications and acquire empirical evidence to help assess the strengths and weaknesses of a measure.
- Implementation: Identify measures to submit for the CMS selection and rollout processes, adopt measures into CMS programs, and seek endorsement.
- Use, Continuing Evaluation, and Maintenance: Ensure that the measure continues to add value to quality reporting measurement programs and that its construction continues to be sound.
CMS uses the following decision criteria throughout the measure development cycle to ensure a measure meets the applicable standards before moving to the next phase:
- Importance to measure and report—including analysis of opportunities for improvement such as reducing variability in comparison groups or disparities in healthcare related to race, ethnicity, age, or other classifications.
- Scientific acceptability—including analysis of reliability, validity, and exclusion appropriateness.
- Feasibility—including evaluation of reported costs or perceived burden, frequency of missing data, and description of data availability.
- Usability—including planned analyses to demonstrate that the measure is meaningful and useful to the target audience. This may be accomplished by the TEP reviewing the measure results such as means and detectable differences, dispersion of comparison groups, etc. More formal testing, if requested by CMS, may require assessment via structured surveys or focus groups to evaluate the usability of the measure (e.g., clinical impact of detectable differences, evaluation of the variability among groups).
Measure Development Timeline
Developing a measure is a complex and involved process and many of the phases take significant time to ensure a quality product. The diagram below is illustrative of the complexity and timeframe needed to develop a measure.