NQF Approves Criteria for Evaluating Composite Measures

(NQF: Washington, DC) -- To continue improving health care quality through measurement and public reporting, the National Quality Forum (NQF) has identified and approved  criteria for evaluating composite measures. The majority of the hundreds of NQF-endorsed quality measures focus on a single-care process, or even one step in the care process. Composite measures are a combination of two or more individual quality measures in a single measure that results in a single score.  

With the increasing interest in composite measures, a steering committee was appointed to address the additional considerations that are specifically relevant to evaluating such measures.

Within this project, NQF also endorsed composite measures in the areas of adult patient safety, mortality for selected conditions, and pediatric patient safety.

“Health care is a complex and multidimensional activity, and measurement of its quality should reflect that fact,” says Janet Corrigan, NQF president and CEO. “Having a standardized set of criteria for evaluation of composite measures will enable measurement that is richer, as composite measures extend measurement beyond tracking performance, providing a broader picture of health care quality so consumers can make more informed choices about their care and health care systems can get a deeper view of the reliability of the system.” 

In expanding its established evaluation criteria to encompass composite measures, NQF developed a comprehensive evaluation framework, including a glossary of terms. To facilitate measure submission, NQF has also developed an adjunct form for measure developers to use in submitting composite measures for review.  

Before being endorsed, all composite measures must meet NQF’s standard endorsement criteria of being important to measure and report, scientifically acceptable, feasible, and usable.

Additional considerations for composite measures include the need to standardize scores of the components if they have different scales or directionality; whether the components should be weighted differently and for what reasons; and whether the scoring method is appropriate. 

“This effort is a great step forward in establishing a method to evaluate proposed composite measures and ensure that approved measures are useful and scientifically valid,” says Harlan Krumholz professor of internal medicine at Yale University School of Medicine and co-chair of NQF’s composite evaluation steering committee. “A good composite is not simply the combination of other measures, but needs to be well conceived, developed, and tested to ensure it meets standards that would make it suitable for public reporting and consequential in driving improvements in health care. Often we benefit from these composite measures, which summarize the signals from a larger group of more focused assessments of quality.” 

NQF will continue to use the newly endorsed composite evaluation criteria to endorse composite measures for future projects.  

For more information, visit www.qualityforum.org.

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