How Endorsement Happens 


For more than a decade, the National Quality Forum has crafted and continually improved a process to make sure endorsed standards (measures) have cleared NQF’s bar for rigor and balance. The process is designed to produce consensus from a broad spectrum of stakeholders in America's healthcare.

NQF has adopted a regular schedule for measure endorsement in 15 areas, such as cardiology, neurology, and perinatal care. To respond to new developments that signal a need for updated standards for patient care, NQF also has a process to consider "ad-hoc" endorsement projects outside of the schedule.

For each Consensus Development Process project, NQF follows a careful process that ensures transparency, public input, and discussion among representatives across the healthcare spectrum.

  1. Intent to Submit starts a minimum 90-day period for developers to inform NQF of their intent to submit measure for maintenance evaluation or an initial review for endorsement through NQF’s online submission form
  2. Call for Nominations allows anyone to suggest a candidate for a given standing committee that will oversee a project. Committees are diverse, often encompassing experts in a particular field, providers, scientists, and consumers. After selection, NQF posts committee rosters on its website to solicit public comments on the composition of the panel and makes adjustments as needed to ensure balanced representation.
  3. Measure Review applies a five-part criteria to submitted measures to ensure they reflect sound science, will be useful to providers and patients, and will make a difference in improving quality. The expert standing committee conducts this detailed review in open sessions, each of which includes a public comment period.
  4. Public Comment with Member Support solicits input from anyone who wishes to respond to a draft report that outlines the standing committee’s assessment of measures for possible endorsement. The standing committee may request a revision to the proposed measures as a result of public comment. In addition, NQF members are able to express their support on measures submitted for endorsement.
  5. Measure Endorsement marks the point at which the NQF Consensus Standards Approval Committee (CSAC) makes endorsement decisions, after deliberating on the merits of the measure and the issues raised during the review process. The CSAC includes consumers, purchasers, healthcare professionals, and others. It ensures that standards are consistently assessed from project to project.
  6. Measure Appeals opens a period when anyone can appeal a CSAC measure endorsement decision. All appeals are submitted and reviewed by NQF's Appeals Board under an appeals process