Quality Measure

Types of Quality Measures

Quality measures fall into four primary categories defined by Donabedian's framework:

• Structure measures: Assess the capacity to provide quality care — electronic health record use, patient-to-physician ratios, board certification. Example: MIPS Promoting Interoperability category.
• Process measures: Track whether evidence-based care steps are completed. Example: Percentage of diabetic patients with A1C tested in past 12 months. Most MIPS and HEDIS measures are process measures.
• Outcome measures: Measure the results of care — A1C < 8%, 30-day readmission rate, mortality rate. Outcome measures are the most meaningful but require risk adjustment and sufficient sample size.
• Patient experience measures: Capture patient-reported perceptions of care. HCAHPS, CAHPS, and patient satisfaction surveys fall in this category.

Numerator, Denominator, and Exclusions

Every quality measure specification includes three core components:

• Initial Patient Population (IPP): The broadest set of eligible patients who might qualify for the measure
• Denominator: The subset of IPP patients who are actually eligible — typically filtered by condition, age, encounter type, and other criteria
• Denominator Exclusions: Patients who are excluded from the denominator due to clinical reasons (e.g., contraindication to the recommended service)
• Numerator: The subset of denominator patients who received the appropriate service or achieved the desired outcome

Performance rate = Numerator ÷ (Denominator − Denominator Exclusions) × 100%.

NQF Endorsement

The National Quality Forum (NQF) is the primary standards-setting body for healthcare performance measurement in the United States. NQF-endorsed measures have undergone a rigorous scientific and stakeholder review process to confirm importance, scientific acceptability, usability, and feasibility. NQF measure numbers (e.g., NQF 0059 for Diabetes: HbA1c Poor Control) are referenced in MIPS, HEDIS, and other quality programmes.