Measuring Performance

Maintenance of NQF-Endorsed Performance Measures 

The National Quality Forum (NQF) is committed to ensuring that the healthcare measures it endorses continue to meet rigorous NQF's measure evaluation criteria (PDF). 

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. Endorsed measures are reviewed and maintained using the following three processes:

  • Measure Maintenance Review 
  • Early Maintenance Review
  • Annual Update 

Measure Maintenance Review

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.

For more information on NQF’s maintenance processes, please see the Measure Developer Guidebook.

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)

Early Maintenance Review

An early maintenance review is a formal measure evaluation and endorsement reconsideration that occurs prior to the previously scheduled maintenance of endorsement date. An early maintenance review will follow the same process as a maintenance of endorsement evaluation.

An early maintenance review may be triggered in a variety of ways:

  1. A material change to an endorsed measure is submitted by a measure developer during an annual update. A material change is defined as any significant modification to the measure specifications that significantly affects the measure results such as:
    1. a change to the population being measured (e.g., changes in age inclusions, changes in diagnoses or other inclusion criteria, changes in excluded populations, from one type of insured population to all-payer population);
    2. changes to what is being measured (e.g., changes in target values like blood pressure or lipid values);
    3. inclusion of new data source(s); or
    4. expanding the level or changing unit of analysis or care settings (e.g. adding clinician-level to a measure that is endorsed for practice-level)
  • Directive by the Standing Committee or the CSAC to review a specific criterion sooner than the scheduled maintenance of endorsement evaluation.
  • Request by a developer or third party. An early maintenance review can be requested by any party, as long as there is adequate evidence to justify the review.

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.

Learn more about the early maintenance review process (PDF).

Annual Update

Following the new or continued endorsement of a measure, measure stewards have the option to submit a status report of the measure specifications to NQF. The steward/developer may request to provide an annual update by contacting or by submitting a technical assistance request in the Measure Information Management System (MIMS). NQF will conduct a review of received annual updates on a quarterly basis.

This submission 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 early maintenance review of the measure if the changes materially affect the measure’s original concept or logic.

Contact Information  

For further guidance and questions, please contact