U.S. Department of Health and Human Services: Decision Rules for Categorizing Measures of Health, Health Care Quality, and Health Care Affordability

The U.S. Department of Health and Human Services (HHS) has published this guide for the categorization of measures of health, health care quality, and health care affordability based on the priorities in the National Quality Strategy for Improvement in Health Care.

The multiple divisions within HHS currently use thousands of measures to evaluate and improve health and health care. Efficiently using these measures― and additional measures under development―requires that HHS understand what these measures represent. Analyzing HHS’ set of measures according to the National Quality Strategy priorities, settings of care, and level of health care system is a key step in helping to achieve this understanding. An improved and shared understanding of these measures will facilitate better identification of measure gaps, priorities for new measure development, as well as any instances of a surplus of measures . It will also help improve coordination of new measure development and harmonization of existing measures, and provide insight on how best to move towards achieving a set of highly effective measures that minimizes measurement burden, while providing all stakeholders with useful information on health and healthcare.

Decision rules are written, explicit, logic statements that make clear the criteria that must be met in order to assign a measure into a particular measure category. The decision rules also use standardized definitions of concepts and criteria. Decision rules are available to all stakeholders.  These decision rules were endorsed by the HHS Measures Policy Council, representing key divisions within HHS. The Measures Policy Council will continuously review and revise the decision rules as needed.

Notably, the decision rule categories do not include a separate category for measures of heath care equity or disparities in health or health care. Although concern with eliminating disparities in care and taking into consideration the different health and health care needs of individuals are explicit principles of the National Quality Strategy, the absence of a separate category for such measures is due to the belief that all measures of health and health care can serve as such measures. While not all measures are specified for stratification according to such concepts as race, ethnicity, or socio-economic status, when measures are implemented across different groups and the results stratified, they can provide reliable information on differences in the health or healthcare across these groups, and thus provide information on disparities or inequities in health and health care.

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