Measure Lifecycle by Stage
Quality Measure Lifecycle Overview
Quality measures are standards for measuring the performance and improvement of health and healthcare services. They serve as tools to assess healthcare processes, outcomes, patient perceptions, and organizational structure or systems that are associated with high-quality healthcare and the health of populations. Quality measurement goals include healthcare that is effective, safe, efficient, patient-centered, equitable, and timely. CMS uses quality measures in its quality improvement, public reporting, pay-for-reporting programs, and value-based purchasing programs.
The goal of measure development is a precisely specified, valid, and reliable measure that is meaningful to clinicians, patients, and caregivers.
CMS manages a standardized approach (as documented in the Blueprint) for developing and maintaining such quality measures that are used in various quality initiatives and programs. This approach is made up of a set of business processes and decision criteria that CMS-funded measure developers follow in the development, implementation, and maintenance of quality measures.
Measure Lifecycle Stages
There are five stages in the Measure Lifecycle. The stages are not necessarily sequential, but are iterative, and can occur concurrently. The figure below and the following descriptions describe the lifecycle in more detail.
- Conceptualization: Develop measure concepts and then narrow down to specific measures. The measure developer conducts an environmental scan and requests input from a broad group of stakeholders, including individuals, patients, and families.
- Specification: Identify the population, the recommended practice, the expected outcome and determine how to measure the concept.
- Testing: Assess the suitability of the quality measure’s technical specifications and use data to help assess the strengths and weaknesses of the 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 the continued soundness of the measure by providing strong evidence that the measure continues to add value to CMS programs.
Throughout the Measure Lifecycle, measure developers apply standardized evaluation criteria to develop robust and meaningful measures. The measure evaluation criteria are:
- Importance to measure and report, including evidence and performance gaps, and priority (i.e., impact)
- Scientific acceptability of measure properties, including reliability and validity
- Usability and use
- Comparison to related or competing measures—harmonization
Measure developers should strive to identify weaknesses in the justification for their measure—through applying evaluation criteria—and revise and strengthen the measure during development. The Measure Evaluation Report Template and Instructions (DOCX)and documents on the National Quality Forum (NQF) Submitting Standards page are available to assist the measure developer in documenting measure evaluation.
Measure Lifecycle Timeline
The figure below describes a high-level view of the major tasks and timeline involved in developing measures, from initial measure conceptualization through measure implementation and maintenance. Measure developers conduct feasibility evaluation, information gathering, and stakeholder engagement on an ongoing basis throughout the Measure Lifecycle. CMS and other stakeholders are working to shorten the measure timeline for more rapid development and implementation of new measures.