What is a Quality Measure

What is a Quality Measure?

Quality measures are standards for measuring the performance of healthcare providers to care for patients and populations. Quality measures can identify important aspects of care like safety, effectiveness, timeliness, and fairness.

What do they measure?

Each quality measure focuses on a different aspect of healthcare delivery, and together quality measures and quality measurement provide a more comprehensive picture of the quality of healthcare. Quality measures address many parts of healthcare, including:

  • Health outcomes
  • Clinical processes
  • Patient safety
  • Efficient use of healthcare resources
  • Care coordination
  • Patient engagement in their own care
  • Patient perceptions of their care
  • Population and public health

What are the parts of a quality measure?

A quality measure is made up of several parts:

  • A title and description of what the measure is.
  • Numerator (also called the measure focus): describes the target process, condition, event, or outcome expected for the targeted population.
  • Denominator: defines the population being measured. It could be the whole population or a subset.
  • Denominator exclusion: identifies members of this population who should not be included in the measure population (or the denominator).

Note: Some measures also have numerator exclusions and/or denominator exceptions, as well as other components.

For more information, read the Measure Specification chapter of the Blueprint (PDF).

Example of a Quality Measure
   
Description Percentage of patients 18-85 years of age who had a diagnosis of high blood pressure and whose blood pressure (BP) was adequately controlled (< 140/90 mmHg) during the measurement period.
Numerator Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period.
Denominator Patients 18-85 years of age who had a visit and a diagnosis of high blood pressure.
Denominator Exclusions

Do not include the following patients:

  • Hospice services given to patient any time during the measurement period.
  • Documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period.
  • Pregnancy during the measurement period.
  • Patients age 66 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54, or 56 for more than 90 days during the measurement period.
  • Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period.
  • Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, emergency department, or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period.
  • Patients 81 years of age and older with an evidence of frailty during the measurement period.
Rationale
  • One out of every three Americans have hypertension, or high blood pressure (Fields, 2004).
  • Even with the availability of effective treatment options, more than half of Americans with hypertension are untreated or do not have optimal levels of blood pressure while under treatment (AHA, 2010).
  • Improvements in quality or better control of blood pressure as related to this measure would help significantly reduce the probability of serious and costly complications, including coronary artery disease, congestive heart failure, stroke, ruptured aortic aneurysm, renal disease, and retinopathy.

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Page Last Modified:
12/01/2021 08:00 PM