Article Text

Download PDFPDF
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}


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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.