NQMC Measure Domain Framework

The National Quality Measures Clearinghouse (NQMC) was a database of measures meeting specific criteria for inclusion. Measures in NQMC were classified into domains according to the domain framework below.

There are many dimensions of performance related to clinical health care delivery and population health within which measures can be developed. The classification of measures into domains within NQMC was based on a number of rationales:

  • Keep the organization of measures consistent with historical conventions, and extend those conventions.
  • Clarify the purpose and use of measures for developers and users.
  • Simplify search and retrieval of measures within the NQMC.
  • Accommodate the expanding range of measure types over time, beyond the common focus on Process, Outcome, Access and Structure.

Health care delivery measures are used to assess the performance of individual clinicians, clinical delivery teams, delivery organizations, or health insurance plans in the provision of care to their patients or enrollees. Population health measures are applied to groups of persons identified by geographic location, organizational affiliation or non-clinical characteristics, in order to assess public health programs, community influences on health, or population-level health characteristics that may not be directly attributable to the care delivery system.

The classification of domains that appears below relied on a concept of criterion of quality that differentiates quality measures from related measures. In practical terms, the criterion of quality determines whether a higher or lower score for a measure indicates better care. That is, if two results derived using the same measure differ then the measure's supporting evidence must indicate whether the higher of the two results represents better or worse quality than the lower result. The type of evidence on which this criterion is based varies by domain as described in the definitions [link to Domain Definitions page].

Health care delivery measures and population health measures can each be classified into three parallel sub-groups: quality measures, related measures and efficiency measures. By definition, clinical and population health quality measures incorporate a criterion of quality, which differs by domain as described in the definitions below. Related health care and population health measures describe other activities or characteristics that are not supported by evidence regarding quality of care. Efficiency measures include both a quality component and a cost component.

Figure:

NQMC’s measures: 1) health care delivery measures including a) clinical quality, b) related health care delivery, and c) clinical efficiency; 2) population health measures including a) population health quality, b) related population health, and c) population efficiency

The above Domain Framework Figure depicts the organization of the domains used to classify measures in the NQMC. Measures related to health are categorized as Health Care Delivery Measures and Population Health Measures.

Text in the Figure notes that Health Care Delivery Measures are used to assess the performance of individual clinicians, clinical delivery teams, delivery organizations, or health insurance plans in the provision of care to their patients or enrollees. The denominators for these measures are defined by some form of affiliation with a clinical care organization. The figure depicts three subcategories of Health Care Delivery Measures. These include (1) Clinical Quality Measures, including the domains of Process, Access, Outcome, Structure, and Patient Experience; (2) Related Health Care Delivery Measures, further categorized as User-Enrollee Health Status, Management, Use of Services and Cost; and (3) Clinical Efficiency Measures, reflecting the domain of Efficiency.

The Figure’s text also notes that Population Health Measures are applied to groups of people identified by geographic location or relationship to organizations that are not primarily focused on delivering or paying for health care, such as schools or prisons. Performance on these measures falls to public officials, public health programs, or other entities that are not health care delivery organizations. The figure depicts three categories of Population Health Measures. These include (1) Population Health Quality Measures, including Population Process, Access, Outcome, Structure, and Experience domains; (2) Related Population Health Measures, further categorized as Population Health State, Management, Use of Services, Cost, Health Knowledge, as well as Social Determinants of Health and Environment domains; and (3) Population Efficiency Measures, reflecting the domain of Efficiency.

Page last reviewed July 2018
Page originally created July 2018
Internet Citation: NQMC Measure Domain Framework. Content last reviewed July 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/gam/summaries/domain-framework/index.html