Performance measures are used to identify opportunities for improving patient care, comparing various dimensions of quality and cost across organizations and geographic areas. They may be used for improvement efforts, value-based payment programs, public reporting, patient decision-making, accountability, or allocating resources toward identified gaps in community and population health needs.
Key Facts
- Importance:
- Evidence-Based: The measure should be grounded in scientific evidence and aim to improve outcomes that are meaningful to patients.
- Substantial Potential for Improvement: There should be a significant gap between optimal and current performance, or a disparity in care across population groups that can be improved through feasible interventions.
- Severity and Prevalence: The condition being measured should have significant severity and prevalence in the population to justify targeting it for improvement.
- Substantial Impact: The measure should be patient-centered and address a national health priority or have the potential for substantial impact on health status, outcomes, and/or healthcare experience.
- Relevant: The measure should be important to physicians and their patients, kept up-to-date with current knowledge, and amenable to evaluation.
- Improve Value: Measures should have the potential to improve the value of health services for patients, plans, and purchasers of healthcare.
- Scientific Acceptability:
- Reliability: The measure should be clearly defined, reproducible, and consistent across different practice settings.
- Validity: The measure should be consistent with high-quality evidence of efficacy and effectiveness, accurately represent the concept of interest, and have face and construct validity.
- Precisely Defined and Specified: The measure specifications should include the rationale, performance measure population, well-defined denominator, data elements, and sources, among other details.
- Transparency: The measure should be easily and consistently interpreted by users.
- Risk Adjusted: If appropriate, the measure should be risk-adjusted to account for factors beyond a physician’s or health system’s control, such as practice settings, patient preferences, comorbid conditions, cultural factors, and social determinants of health.
- Feasibility:
- Improvement Attainable: The health outcome goal of the measure should be achievable in the settings where it is applied.
- Reasonable Cost: The measure should not impose an inappropriate financial burden on data collection and implementation efforts, with costs justified by the impact on patient-oriented outcomes.
- Reasonable Time and Effort: Data collection and reporting should not impose undue burden, with data preferably available in electronic health records or other electronic sources.
- Harmonization: Measures should be compared and harmonized if similar or competing measures exist, unless multiple measures are justified.
The American Academy of Family Physicians (AAFP) has established criteria for evaluating the need, quality, and acceptability of a performance measure. These criteria are categorized into three main groups: importance, scientific acceptability, and feasibility.
Importance
- Evidence-BasedThe measure should be grounded in scientific evidence and aim to improve outcomes that are meaningful to patients.
- Substantial Potential for ImprovementThere should be a significant gap between optimal and current performance, or a disparity in care across population groups that can be improved through feasible interventions.
- Severity and PrevalenceThe condition being measured should have significant severity and prevalence in the population to justify targeting it for improvement.
- Substantial ImpactThe measure should be patient-centered and address a national health priority or have the potential for substantial impact on health status, outcomes, and/or healthcare experience.
- RelevantThe measure should be important to physicians and their patients, kept up-to-date with current knowledge, and amenable to evaluation.
- Improve ValueMeasures should have the potential to improve the value of health services for patients, plans, and purchasers of healthcare.
Scientific Acceptability
- ReliabilityThe measure should be clearly defined, reproducible, and consistent across different practice settings.
- ValidityThe measure should be consistent with high-quality evidence of efficacy and effectiveness, accurately represent the concept of interest, and have face and construct validity.
- Precisely Defined and SpecifiedThe measure specifications should include the rationale, performance measure population, well-defined denominator, data elements, and sources, among other details.
- TransparencyThe measure should be easily and consistently interpreted by users.
- Risk AdjustedIf appropriate, the measure should be risk-adjusted to account for factors beyond a physician’s or health system’s control, such as practice settings, patient preferences, comorbid conditions, cultural factors, and social determinants of health.
Feasibility
- Improvement AttainableThe health outcome goal of the measure should be achievable in the settings where it is applied.
- Reasonable CostThe measure should not impose an inappropriate financial burden on data collection and implementation efforts, with costs justified by the impact on patient-oriented outcomes.
- Reasonable Time and EffortData collection and reporting should not impose undue burden, with data preferably available in electronic health records or other electronic sources.
- HarmonizationMeasures should be compared and harmonized if similar or competing measures exist, unless multiple measures are justified.
By utilizing these criteria, the AAFP and other organizations can evaluate the quality and appropriateness of performance measures, ensuring that they are meaningful, accurate, and actionable in improving healthcare quality and outcomes.
References
- Performance Measures Criteria | AAFP
- How to Evaluate & Measure Employee Performance (+Metrics)
- The Five Traps of Performance Measurement
FAQs
What is the purpose of performance measures?
Performance measures are used to identify opportunities for improving patient care, comparing various dimensions of quality and cost across organizations and geographic areas. They may be used for improvement efforts, value-based payment programs, public reporting, patient decision-making, accountability, or allocating resources toward identified gaps in community and population health needs.
What are the main categories of criteria for evaluating performance measures?
The main categories of criteria for evaluating performance measures are importance, scientific acceptability, and feasibility.
What are some examples of criteria for evaluating the importance of a performance measure?
Examples of criteria for evaluating the importance of a performance measure include whether it is evidence-based, has substantial potential for improvement, addresses a severe and prevalent condition, has a substantial impact on patient care, is relevant to physicians and patients, and improves the value of healthcare services.
What are some examples of criteria for evaluating the scientific acceptability of a performance measure?
Examples of criteria for evaluating the scientific acceptability of a performance measure include whether it is reliable, valid, precisely defined and specified, transparent, and risk-adjusted.
What are some examples of criteria for evaluating the feasibility of a performance measure?
Examples of criteria for evaluating the feasibility of a performance measure include whether it is attainable, has a reasonable cost, requires reasonable time and effort, and is harmonized with other measures.
Who is responsible for evaluating performance measures?
The responsibility for evaluating performance measures typically lies with organizations such as the American Academy of Family Physicians (AAFP), the National Quality Forum (NQF), and the Centers for Medicare and Medicaid Services (CMS). These organizations work with healthcare professionals, researchers, and other stakeholders to develop and endorse performance measures that meet established criteria.
How often should performance measures be evaluated?
Performance measures should be evaluated regularly to ensure that they remain relevant, accurate, and actionable. The frequency of evaluation may vary depending on the measure and the organization responsible for evaluating it.
How can performance measures be used to improve healthcare quality and outcomes?
Performance measures can be used to identify areas where healthcare quality can be improved. By tracking performance over time, organizations can identify trends and patterns that may indicate opportunities for improvement. Additionally, performance measures can be used to compare the performance of different healthcare providers and organizations, which can help to drive competition and encourage providers to improve their performance.