Table 6. Types of scoring methods for composite measures (excluding empirically derived scoring methods)

Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives

Scoring Method for
Composite
DefinitionExampleAdopting Organization
All or NoneThe percentage of patients for whom all indicators triggered by that patient are met"Appropriate Care Measure" for 4 conditions (8 heart attack, 4 heart failure, 7 pneumonia, and 5 Surgical Care Improvement Project treatments [per Joint Commission]). Patients must receive all identified interventions for a condition to be included in the numerator.Pennsylvania Health Care Quality Alliance's Progress and Performance Report of Hospital Quality
70% StandardBased on all or none with less strict criteria; 70% or more of indicators must be triggered.None to our knowledge (but hypothetically attractive). 
Overall Percentage (Opportunity Weighting)Percentage of all audited care events that are met, where each opportunity to "do the right thing" counts equally.149 hypertensive patients triggered 26 hypertension indicators 828 times. Required care was given 576 times, yielding 69.6% (576/828).Centers for Medicare & Medicaid (CMS) Pay for Performance (P4P) Premier Hospital Quality Incentive Demonstration Project86
Indicator Average (Equal Indicator or Event Weighting)For each indicator, the percentage of times the indicator was met is computed and scores are averaged across all indicators. This represents the mean rate at which each aspect of care was met.Hospital quality of care for acute myocardial infarction, congestive heart failure, and pneumonia is rated by averaging multiple indicators within each clinical domain.Hospital Quality Alliance (HQA
Patient Average (Equal Patient Weighting)The percentage of triggered indicators successfully met is computed for each patient. Scores are averaged across all patients to represent the mean percentage of audited aspects of care met for each patient.None to our knowledge (but hypothetically attractive). 
Expert Opinion (Evidence Based)Each indicator is weighted based on evidence of its impact on population health or evidence of the effort required to achieve it.General Medical Services contract pays physicians more for achieving performance targets that require more time and other resources.United Kingdom National Health Service

Source: Definitions and examples in this table are summarized and adapted from Reeves, et al.,80 and the Pennsylvania Health Care Quality Alliance.

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Current as of May 2010
Internet Citation: Table 6. Types of scoring methods for composite measures (excluding empirically derived scoring methods): Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. May 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/perfmeasguide/perfmeaspt2tab6.html