Maintenance of NQF-Endorsed® Performance Measures 

Measure Endorsement

As an endorsing body, NQF is committed to ensuring the performance measures it endorses continue to meet the rigorous NQF measure evaluation criteria (PDF). Every three years, endorsed measures are re-evaluated against this criteria and are reviewed alongside newly submitted (but not yet endorsed) measures. This head-to-head comparison of new and previously endorsed measures fosters harmonization and helps ensure NQF is endorsing the best available measures.

NQF’s measure endorsement - which includes this important three-year review of previously endorsed measures - is standardized in a regular cycle of topic-based measure evaluation. NQF follows a schedule of review for maintenance of endorsement of measures in 21 topic areas, including as cardiology, neurology, perinatal, and infectious disease. As the need arise, these topic areas may be revised to account for measures that may require a new or more appropriate topic area.

Each topic-based review of new and previously endorsed measures follows NQF’s Consensus Development Process®, which allows for the submission of new measures, review by an expert Standing Committee, public and Member comment, Member voting, consideration by the Consensus Standards Approval Committee (CSAC), endorsement by the Board of Directors, and a 30-day appeals period. At the end of this process, a set of measures around a specific topic area (e.g. cardiology) may be endorsed.

Measure Maintenance

NQF recognizes the need to ensure that the endorsement and maintenance process enables the portfolio of measures to change over time, while continuing to provide consistency and currency for those individuals and organizations implementing the measures. For more information on NQF’s maintenance processes review the policy below.

As part of the maintenance review process, NQF is interested in how endorsed measures are being used. Measure users have the opportunity to submit comments on measures in use via NQF's Quality Positioning System (QPS), a measure search tool. NQF is also a facilitator in the ICD-10 coding conversion process. Learn more about our approach (PDF). 

Annual Update 

Following the (continued) endorsement of a measure, measure stewards will submit a status report of the measure specifications to NQF on an annual basis. This report will either reaffirm that the measure specifications remain the same as those at the time of endorsement or last update, or outline any changes or updates made to the endorsed measure.

If any changes occur to a measure at any time within the three-year endorsement period, the measure steward is responsible for informing NQF immediately of the timing and purpose of these changes. An ad hoc review will be conducted if the changes materially affect the measure’s original concept or logic.

Ad Hoc Review

An ad hoc review is a formal measure evaluation and endorsement reconsideration outside of the scheduled maintenance of endorsement process. An ad hoc review is limited and focused on a specific issue regarding an evaluation criterion and is not the same as a maintenance of endorsement evaluation. An ad hoc review may be triggered in a variety of ways:

  • A material change to an endorsed measure is submitted by a measure developer during an annual update. Material change is defined as any modification to the measure specifications that significantly affects the measure result such as:
    • change to the population being measured ( e.g., changes in age inclusions, changes in diagnoses or other inclusion criteria, changes in excluded populations);
    • changes to what is being measured (e.g., changes in target values like blood pressure or lipid values);
    • inclusion of new data source(s); or
    • expansion of the level of analysis or care settings.

NOTE: Minor coding changes resulting from usual changes to the coding system or addition of new drugs to a measure with already specified family of drugs, are not considered material changes.

  • Directive by the Standing Committee/the Consensus Standards Approval Committee (CSAC)/ NQF Board of Directors to review a specific criterion sooner than the scheduled maintenance of endorsement evaluation.
  • Request by a developer or third party. An ad hoc review can be requested by any party, as long as there is adequate evidence to justify the review.

Learn more about the ad hoc review process (PDF).

NQF Resources

The Field Guide is an online resource designed to help you easily access NQF resources.