Dr Matthew Pickering: How Quality Measures Are Created and Implemented

The creation and implementation of a new quality measure is a long process that includes considering other measures on the market, actually developing the measure and, ultimately, testing its scientific acceptability, explained Matthew Pickering, PharmD, RPh, associate director of research and quality strategies at the Pharmacy Quality Alliance.

What is the process of getting a newly created measure implemented?

The process originally starts out with developing a measure concept. Before it even moves on to the development phase overall, it starts out as a measure concept, and that measure concept starts with a gap analysis to see where gaps exist in healthcare, to where we can develop a measure to actually fill those gaps. Those gaps could be from evidence that comes out, like clinical practice guidelines, noting that we need to have a patient on a certain medication because we know that sound evidence has told us this.

Once a concept has been developed, we also need to consider what other measures are out there in the market that are along the same lines of this measure concept. If there’s another measure, we don’t necessarily want to create a duplicative measure. It is a harmonization that can happen, of the measure specifications that are already in existence.

After the measure concept is there, it moves on to development. This is where we convene experts from the clinical side and also the technical side to really define the measure specifications. What do our eligible populations look like for the measure? What do our exclusions look like? What’s the numerator, ultimately? What are the data sources that are most appropriate to actually capture the measure concept? And also, what’s the level of accountability? Who are we holding accountable? Is it health plans or providers, individual physicians, et cetera?

Once the measure’s been fully developed, it needs to be tested. It needs to be tested for its scientific acceptability, so is it valid, is it reliable? Also, is it feasible? If it upholds against those criteria, it can then move forward to endorsement. Which, there’s other criteria to consider as well. How is it going to be used? What’s the usability of the measure? Is it really important and impactful to health care? Then, if it passes that, it gets that golden seal of approval of endorsement, and it can then be implemented.

So it’s a long process, and it’s very time-intensive, but it’s needed to develop a good quality measure.