On August 21, 2002, AHRQ issued a call for measures for inclusion in its new National Quality Measures Clearinghouse™ (NQMC), a Web-based repository of tools for measuring health care quality. AHRQ is sponsoring the development of NQMC to promote widespread access to quality measures by the health care community and other interested individuals. The scheduled availability date for the NQMC Web site is Winter 2002.
NQMC is a significant enhancement to the Agency's CONQUEST library of performance measures and is intended for use by health care providers, managers, policymakers, and others interested in health care quality measurement. Below are inclusion criteria and other details for submitting measures. Submissions can be made on an ongoing basis.
NQMC inclusion criteria rely on the following definitions:
- Quality of care: The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
- Measure: A tool to assign a quantity to an attribute by comparing it with a criterion.
- Quality measure: A tool to assign a quantity to quality of care by comparing it with a criterion.
- Clinical performance: The degree of accomplishment of desired health objectives by a clinician or health care organization.
- Clinical performance measure: Subtype of a quality measure that is a tool for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in the optimal time period.
Submission and Selection of Measures
The submission of measures to be considered for inclusion in the NQMC is an ongoing process. Measures are submitted to the NQMC by national, State, and local organizations involved in developing and/or using quality measurement tools. These include health care systems, accreditation organizations, professional associations, research institutions, licensing boards, and other relevant organizations.
Measures nominated for inclusion in the NQMC are screened initially according to three broad attributes:
- Importance of the measure.
- Scientific integrity.
These three broad categories were established based on input from national organizations, consensus-development workgroups, and researchers in the field.
For a measure to be considered for inclusion in the NQMC, submitters must provide supporting material, including measure specifications and supporting documentation. To be included in the NQMC, a measure must meet all of the following requirements. If a measure fails to meet one or more of the inclusion criteria below, the submission forms will be returned to the submitter with a request for further documentation or development in the identified area. The submitter may revise and resubmit the measure.
The measure must address some aspect(s) of quality of care delivered to defined patients by a defined individual, group of individuals, or organization(s) and must relate to at least one of the following domains (the submitter should indicate the one domain that fits the best):
- Process of care—a health care service provided to or on behalf of a patient.
- Outcome of care—a patient's health state resulting from health care.
- Access to care—the patient's attainment of timely and appropriate health care.
- Patient experience of care—a patient report about observations of and participation in health care.
The submitter must provide English documentation that includes each of the following three items:
- Rationale for the measure—a brief statement describing the patients and the specific aspect of health care to which the measure applies. The rationale also may include the evidence basis for the measure and an explanation of how to interpret results, if that information is provided.
- Description of the denominator and numerator of the measure (including specific variables for inclusion or exclusion of cases from either the denominator or numerator).
Note: A continuous variable statement (e.g., "time to thrombolysis") may be an acceptable alternative, and measures whose metric is other than a rate or percentage will be considered on an individual basis.
- Data source(s) for the measure.
The submitter should provide documentation of supporting evidence appropriate for the measure domain:
- Process measure—evidence that the measured clinical process has led to improved health outcomes.
- Outcome measure—evidence that the outcome measure has been used to detect the impact of one or more clinical interventions.
- Access measure—evidence that an association exists between the result of the access measure and the outcomes of or satisfaction with care.
- Patient experience measure—evidence that an association exists between the measure of patient experience of health care and the values and preferences of patients/consumers.
The documentation must consist of at least one of the following types of evidence:
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal.
- A systematic review of the clinical literature.
- A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence.
- A formal consensus procedure involving expert clinicians and clinical researchers.
Additionally, for patient experience measures, evidence should include focus groups involving patients and/or cognitive testing of the measures by patients. For access measures, the consensus panel should also include other relevant stakeholders.
At least one of the following criteria must be satisfied with specific information attached in each case:
- The measure has been cited in one or more reports in an NLM-indexed, peer-reviewed journal, applying or evaluating the measure's properties.
- The submitter provides documented peer-reviewed evidence evaluating the reliability and validity of the measure. Reliability is the degree to which the measure is free from random error. Validity is the degree to which the measure is associated with what it purports to measure.
- The measure has been developed, adopted, adapted, or endorsed by an organization that promotes rigorous development and use of clinical performance measures. Such an organization may be at the international, national, regional, State, or local levels (e.g., a multi-State consortium, a State Medicaid agency, or a health organization or delivery system).
Note: Adapted measures are those measures developed by one organization and then subsequently adopted and modified in some way by another organization.
The measure must be in current use or currently in pilot testing and must be the most recent version, if the measure has been revised. A measure is in current use if at least one health care organization has used the measure to evaluate or report on quality of care within the previous 3 years.
Submission of Measures
Organizations interested in contributing to the NQMC should submit two hard copies of each measure and documentation that the measure meets the NQMC Inclusion Criteria in typed format and electronic (if available), including name, address, phone, and E-mail address of a contact person to:
Vivian H. Coates
NQMC Project Director, ECRI
5200 Butler Pike
Plymouth Meeting, PA 19462-1298
For More Information
Send E-mail to firstname.lastname@example.org.
Select to access the notice calling for NQMC measures in the Federal Register.
Current as of August 2002
Measures Sought for National Quality Measures Clearinghouse™. August 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nqmcmeas.htm