Maintenance of NQF-Endorsed® Performance Measures 

Measure Endorsement

The National Quality Forum (NQF) is committed to ensuring that the healthcare measures it endorses continue to meet rigorous NQF measure evaluation criteria (PDF). Approximately every three years, endorsed measures are re-evaluated against these 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 endorses the best available measures.

NQF’s measure endorsement process, including maintenance of previously endorsed measures, is standardized in a regular cycle of topic-based measure evaluation in 22 areas, such as cardiology, neurology, perinatal, and infectious disease. As the need arises, these topic areas are updated 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), 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.

As of early 2017, CSAC decisions regarding measure endorsement are final, without ratification by the NQF Board of Directors.

Measure Maintenance

NQF recognizes the need to ensure that the measure 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, please see the policies 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 measure search tool, the Quality Positioning System (QPS)

Annual Update 

Following the new or continued endorsement of a measure, NQF requires measure stewards to 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 since that time to the endorsed measure.

If any changes occur to a measure at any time within the three-year endorsement period, NQF asks the measure steward to immediately inform NQF of the timing and purpose of these changes. NQF will conduct an ad hoc review of the measure 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 CSAC/ 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).