Quality Measure Stewardship and Endorsement

Quality measures do not appear from nowhere. They follow a structured development, testing, endorsement, and maintenance lifecycle managed by measure stewards and reviewed by endorsement bodies. Understanding this lifecycle is important for quality professionals.

Measure Stewards

A measure steward is the organization responsible for developing, specifying, maintaining, and updating a quality measure. Major measure stewards include CMS, The Joint Commission, the National Committee for Quality Assurance (NCQA), the Pharmacy Quality Alliance, and various medical specialty societies. The steward ensures that the measure is scientifically sound, clinically relevant, and operationally feasible. They also update the measure as clinical evidence evolves.

Measure Development Process

Measure development typically follows several stages. Conceptualization identifies the quality gap the measure addresses. Specification defines the technical details (numerator, denominator, exclusions, data sources). Testing evaluates reliability (does the measure produce consistent results?) and validity (does it accurately capture the intended quality concept?). Implementation involves piloting the measure in real-world settings to assess feasibility and identify practical challenges.

NQF Endorsement Process

The National Quality Forum evaluates measures against four criteria. Importance assesses whether the measure addresses a significant quality gap with evidence linking the measured concept to better outcomes. Scientific acceptability evaluates the measure's reliability and validity. Feasibility examines whether the data needed is available and collectible at reasonable cost. Usability and use considers whether the results are meaningful and actionable for intended audiences.

Measure Maintenance

Endorsed measures undergo periodic review, typically every three years. During maintenance review, the steward must demonstrate that the measure remains relevant, that performance gaps persist, and that the specifications reflect current clinical evidence and practice standards. Measures may be updated, retired, or replaced during this process.

Implications for Quality Professionals

Quality professionals should understand the endorsement process because it affects which measures are selected for federal programs, how to evaluate the quality of measures used internally, and how to participate in the public comment process to influence measure development and refinement.