[Federal Register Volume 67, Number 162 (Wednesday, August 21, 2002)]
[Notices]
[Pages 54215-54217]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-21326]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Invitation To Submit Quality Measures to AHRQ's National Quality 
Measures Clearinghouse

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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SUMMARY: In response to its legislative mandate to compile health care 
quality measures (see Background section below), the Agency for 
Healthcare Research and Quality (AHRQ) invites

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organizations, and other developers of health care quality measures to 
submit tested (and/or valid and reliable) quality measures for 
inclusion in the World Wide Web-based National Quality Measures 
Clearinghouse (NQMC).
    AHRQ is sponsoring the development of NQMC to promote widespread 
access to quality measures by the health care community and other 
interested individuals. NQMC is designed to be a database for 
information on specific health care quality measures and measure sets. 
The scheduled availability date for the NQMC Web site is December/
Winter 2002.
    Measure developers are asked to submit measures and measure updates 
that meet the NQMC inclusion criteria, along with supporting 
documentation, on an ongoing basis. NQMC will contain descriptive 
summaries of each measure catalogued in the NQMC database. Developers 
have the option of making their entire measure available through NQMC 
or may opt to provide ordering information that NQMC will include in 
the measure summary. NQMC users will be directed to contact the measure 
developer to obtain or purchase the entire measure if it is not 
available via the NQMC Web site. Quality measure summaries will be 
retrievable by many parameters including topic, target population, and 
setting of care. Users of NQMC will be able to search NQMC and the 
National Guideline Clearinghouse\TM\ www.guideline.gov.--
simultaneously.

DATES: Quality measures and measure sets will be received on an ongoing 
basis by ECRI at the address below. ECRI, a nonprofit health services 
research organization, will perform the technical work of the NQMC, 
under contract with AHRQ.

ADDRESSES: Organizations interested in contributing to the NQMC should 
submit two hard copies of each measure and documentation that the 
measure meets the NQMC Inclusion Criteria in typed format and 
electronic (if available), including name, address, phone, and e-mail 
address of a contact person to: Vivian H. Coates, NQMC Project 
Director, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.

FOR FURTHER INFORMATION CONTACT: Forward questions to 
[email protected].

SUPPLEMENTARY INFORMATION:

Background

    AHRQ is the lead Federal agency for enhancing the quality, 
appropriateness, and effectiveness of healthcare services and access to 
such services. In carrying out its mission, AHRQ conducts and supports 
research that develops and presents scientific evidence on methods for 
measuring quality and strategies for improving quality. Under section 
912(a)(2)(C) Title IX, of the Agency for Healthcare Research and 
Quality Act of 1999, AHRQ is charged with compiling health care quality 
measures that have been developed in the public and private sector. To 
this end AHRQ will compile and present measures in the NQMC that have 
been submitted by the public and private sector, and that meet the 
following definitions and inclusion criteria.
    As part of its mandate to use existing technologies to promote 
health care quality improvement, NQMC will use the World Wide Web to 
effectively and efficiently reach a broad audience within the health 
care community. This Web-based repository of quality measures is 
intended to facilitate quick identification and access to quality 
measures by practitioners and health related organizations [e.g., third 
party payers, peer review groups, professional societies submitting 
measures]. The measures will in turn be used to make assessments that 
may ultimately inform health care decisions.

Quality Measure Definition

    The NQMC defines a quality measure as a mechanism to assign a 
quantifier to quality of care by comparison to a criterion.

Criteria

    A measure must meet all of the following criteria to be included in 
the NQMC. If the measures do not meet one or more of these inclusion 
criteria, the submission forms will be returned to the submitter with a 
request for further documentation or development in the identified 
area. The submitter may revise and resubmit measures.
    1. The quality measure must address some aspect(s) of quality of 
care delivered to defined patients by a defined individual, group of 
individuals or organizations and must relate to at least one of the 
following domains: (a) Process of care (a health care service provided 
to or on behalf of a patient); (b) Outcome of care (a health state of a 
patient resulting from health care); (c) Access to care (the patient's 
attainment of timely and appropriate health care); and, (d) Patient 
experience of care (a report by a patient concerning observations of 
and participation in health care).
    2. The submitter must provide English-language documentation that 
includes at least each of the three following items: (i) The rationale 
for the measure (The rationale is a brief statement describing the 
patients and the specific aspect of health care to which the measure 
applies. The rationale may also include the evidence basis for the 
measure, and an explanation of how to interpret results, if that 
information is provided.); (ii) A description of the denominator and 
numerator of the measure (including specific variables for inclusion or 
exclusion of cases from either the denominator or numerator). Note--a 
continuous variable statement (e.g., ``time to thrombolysis'') may be 
an acceptable alternative and measures whose metric is other than a 
rate or percentage will be considered on an individual basis; and, 
(iii) The data source(s) for the measure.
    3. The submitter should provide documentation of supporting 
evidence appropriate for the measure domain: (1) For process measures, 
evidence that the measured clinical process has led to improved health 
outcomes; (2) For outcome measures, evidence that the outcome measure 
has been used to detect the impact of one or more clinical 
interventions; (3) For access measures, evidence that an assoication 
exists between the result of the access measure and the outcomes of or 
satisfaction with care; and (4) For patient experience measures, 
evidence that an association exists between the measure of patient 
experience of health care and the values and preferences of patients/
consumers.
    The documentation must consist of at least one of the following 
types of evidence: (1) One or more research studies published in a 
National Library of Medicine (NLM) indexed, peer-reviewed journal; (2) 
A systematic review of the clinical literature; (3) A clinical practice 
guideline or other peer-reviewed synthesis of the clinical evidence; 
(4) A formal consensus procedure involving expert clinicians and 
clinical researchers.
    Additionally, for patient experience measures, evidence should 
include focus groups involving patients and/or cognitive testing of the 
measures by patients. For access measures, the consensus panel should 
also include other relevant stakeholders.
    4. At least one of the following criteria must be satisfied with 
specific information attached in each case: (1) The measure has been 
cited in one or more reports in a National Library of Medicine (NLM) 
indexed, peer-reviewed journal, applying or evaluating the measure's 
properties; (2) The submitter provides documented peer-reviewed 
evidence evaluating the reliability (the degree to which the measure is 
free from random error) and validity (the degree to which the measure 
is associated with what it

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purports to measure) of the measure; or (3) The measure has been 
developed, adopted, adapted, or endorsed by an organization that 
promotes rigorous development and use of clinical performance measures. 
Such an organization may be at the international, National, regional, 
State or local levels (e.g., a multi-state consortium, a State Medicaid 
agency, or a health organization or delivery system). Note--Adapted 
measures are those measures developed by one organization, and then 
subsequently adopted and modified in some way by another organization.
    5. The measure must be in current use or currently in pilot testing 
and must be the most recent version if the measure has been revised. A 
measure is in current use if at least one health care organization has 
used the measure to evaluate or report on quality of care within the 
previous three years.

    Dated: August 15, 2002.
Carolyn M. Clancy,
Acting Director.
[FR Doc. 02-21326 Filed 8-20-02; 8:45 am]
BILLING CODE 4160-90-M