New NQF Guide Helps to Assign Accountability for Patients 

JAN 17, 2017

CONTACT: Sofia Kosmetatos

New NQF Guide Helps to Assign Accountability for Patients

Washington, DC
—As healthcare payers and consumers increasingly seek greater value from healthcare services, determining which physicians or other providers are ultimately responsible for the quality and outcomes of the care patients receive—a process known as attribution—is paramount. In order to ensure fair and trustworthy methods for determining accountability, the National Quality Forum (NQF) has issued recommendations to help healthcare stakeholders develop, select, and evaluate appropriate attribution models using a new NQF resource, the Attribution Model Selection Guide (PDF).

“NQF’s report on attribution and its accompanying guide provide foundational guidance for the healthcare system amid escalating financial stakes,” said Helen Darling, MA, NQF’s interim president and CEO. “It’s critical that we can accurately identify who is accountable for patients’ care as we work to improve value without sacrificing quality.”

Attribution models are essential parts of measure development and implementation, as well as policy and program design. Currently, there is a wide range of such models in use across the nation, and limited information about model specifics in some cases, prompting concerns from providers and other accountable entities that some models may inaccurately assign accountability for patients or outcomes, as patients see different providers or receive care from teams of clinicians.

Funded by the U.S. Department of Health and Human Services, NQF convened a multistakeholder Committee of 26 clinicians, providers, payers, policy experts, measure developers, and others, to develop a guide for measure developers and other stakeholders who are creating attribution models. The Committee also made recommendations to improve standardization, transparency, and accuracy among attribution models, including that:

  • The Attribution Model Selection Guide should be used to evaluate the factors to consider in the choice of an attribution model.
  • Attribution models should be tested, subject to multistakeholder review, and should attribute results to entities that can influence care and outcomes.
  • Attribution models used in mandatory public reporting or payment programs should meet minimum criteria.

“Much more work is needed to understand the complex issue of attribution and get to more transparent, standardized models that allow for fair evaluation and comparison of models, but this foundational work is an excellent beginning,” said Helen Burstin, MD, MPH, NQF’s chief scientific officer.

This important report, and the guide to attribution model selection, is just one way that NQF is helping to advance measurement science in a rapidly evolving health system. In another recently completed project, NQF provided guidance for minimizing unnecessary variation across similar measures that add reporting burden for providers and make performance comparisons difficult.


The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at