Criteria for Evaluation of Appropriateness of Clinical Quality Measures
| Does it matter to patients? | 1. Patient-oriented outcome: For an outcome measure, the outcome is important to patients (improves quality or quantity of life). For a process measure, the action is likely to lead to an outcome that is important to patients. |
| 2. Autonomy preserved (shared decision-making): Patient autonomy is preserved for decisions in which reasonable, informed patients may make different choices. | |
| Is it appropriately specified? | 3. Denominator specification: The population is clearly and adequately specified with appropriate exclusion criteria and assessment method. |
| 4. Numerator specification: The outcome being measured is clearly and adequately specified with appropriate timeframe and assessment method. | |
| Is there sufficient evidence that benefitsoutweigh harms and costs? | 5. Certainty of net benefit: There is sufficient evidence that the action(s) proposed by the quality measure generate desirable consequences that outweigh undesirable consequences. 6. Measure implementation improves outcomes: There is sufficient evidence that actual implementation of the measure will lead to desirable consequences that outweigh undesirable consequences. 7. Resource use: Measure implementation is likely to produce net benefits that justify the resources (human, material, and financial) expended on its implementation (care provision, measurement, and reporting). |
| Does the measure assess quality, independent of significant confounding factors? | 8. Gaming resistance: Measure implementation is unlikely to motivate a significant number of healthcare providers to change their patient selection, clinical decision-making behavior, or reporting in ways that improve measure performance without improving health outcomes if the measure is implemented. 9. Locus of control: The entity for whom the quality of care is being measured can have sufficient authority, influence, or capacity to affect performance on the quality measure. 10. Social determinants of health: Social determinants of health of the population served do not unduly influence performance on the measure. |