Measuring Performance

Efficiency: Resource Use - Phase I 

Project Status: Completed

Understanding & Evaluating Resource Use Measures (Phase I)


As current health reform efforts focus on expanding coverage to affordable healthcare, it is important to understand how the system uses resources in the context of health outcomes. Aligning resource use (or cost) and quality data will enable he system to better evaluate efficiency of care. By improving efficiency, there is potential to reduce the rate of cost growth and improve the value of care provided. Evidence shows that not all care leads to better outcomes, thus some portion of these current costs may be unnecessary. To identify and provide incentives for providers to deliver high quality, lower-cost care requires quality and resource use measures. The NQF episodes measurement framework specifically highlighted the need for the delivery system to improve health and reduce the burden of illness while maximizing the value of individual and societal resources allocated to health care. In that framework, NQF adopted the following definition of efficiency: a measure of cost of care associated with a specified level of quality of care. Since efficiency measurement is multidimensional, encompassing quality and costs, this effort focuses on identifying and evaluating resource use measures as a building block toward measuring efficiency.

About the Project

The first phase of this resource use measurement project included the development of a paper and expand criteria to evaluate resource use measures.

White Paper 1: Resource Use Measurement

Overview and Criteria for Evaluating Resource Use Measures 

NQF will commission a white paper on criteria for determining the appropriateness of episode-based resource use measures. For emerging measures, such as composites, outcomes, and resource use measures, there is a need for further guidance beyond the standard NQF evaluation criteria in order to review and evaluate these new measure constructs. This paper will lay out the issues for discussion and a review of the evidence for different methodologic approaches to episode-based measures. This phase will also focus on identifying the difficult methodologic issues that require clarification before resource use measures across episodes are evaluated in Phase II.

Under the direction of a steering committee, the white paper laid out the major attributes of resource use measures and the challenges in applying them. This paper was used for guidance to resource use measure developers and to NQF on evaluating submitted resource use measures. This work provided guidance on application to resource use measures and expanding the criteria to address the unique aspects of resource use measures.


This project was guided by a steering committee that considered and made recommendations based on comments from healthcare stakeholders, and existing NQF reports, and prior work. The Steering Committee evaluated, commented, and made relevant recommendations to the enhancement of the paper developed during this process. The Committee used relevant elements of NQF's Consensus Development Process to receive and review comments; however, as this phase of the project did not include the review and assessment of consensus standards, the process did not include a member voting period.


This project is funded under NQF's contract with the Department of Health and Human Services, Consensus-based Entities Regarding Healthcare Performance Measurement.

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Related NQF Work

Contact Information

For further information, please contact Ashlie Wilbon, RN, MPH at 202-783-1300 or via e-mail at

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