Qual Saf Health Care 17:182-186 doi:10.1136/qshc.2006.021170
  • Developing research and practice

When should measures be updated? Development of a conceptual framework for maintenance of quality-of-care measures

  1. S Mattke
  1. S Mattke, the RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA; mattke{at}
  • Accepted 19 August 2007


Objective: To document current practices on long-term maintenance of quality measures and to develop a consensus framework to guide the design of maintenance systems.

Study Design: Survey of 10 organisations developing measures and selected researchers in the USA about current policies and procedures and desirable properties for a comprehensive system for measures maintenance. Panel discussions with all respondents to arrive at consensus recommendations for a framework for maintenance of measures.

Participants: Five measures developers, two provider and three purchaser organisations. Six were private sector organisations, two were governmental agencies, and two were accreditation institutions.

Principal findings: All organisations had procedures for measures maintenance, but the degree of formalisation of the procedures varied. Three key functions for a measures maintenance system emerged: ad hoc review to deal with unexpected problems; annual maintenance to incorporate changes in coding conventions; and regular re-evaluation to thoroughly review measures at predefined intervals. Importance, scientific soundness, feasibility and usability were universally used as evaluation criteria. The panel discussions yielded a consensus set of recommendations for relationships between maintenance functions, evaluation criteria and measures disposition.

Conclusions: A sufficient degree of implicit consensus was found among leading measures developers to arrive at a consensus framework for policies and procedures for measures maintenance. Although organisations may choose to implement the framework in a way that is most consistent with their mission and structure, it provides guidance regarding which components should be included.


  • Funding: This work was funded through a subcontract of the RAND Corporation with the Health Service Advisory Group, Inc, under contract CMS SS-26C with CMS.

  • Competing interests: None declared.

  • The opinions expressed in this paper are those of the author and not of CMS, RAND or the Health Service Advisory Group.

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