Efficiency: Resource Use - Phase II 

Project Status: Completed

Endorsing Resource Use Standards (Phase II)

Final Publications:   

The Opportunity 

As current health reform efforts focus on expanding coverage to affordable care, 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 the system to better evaluate efficiency 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

Phase II of this project began in January 2011.

The first phase of this resource use measurement project included the development of a paper and expanded criteria to evaluate resource use measures. The whitepaper can be accessed here.

In this phase NQF is evaluating and endorsing resource use measures for reporting at multiple levels, including the individual and group physician level. This consensus development project specifically includes evaluation of resource use measures, including per capita and episode-based measures for 13 disease and condition areas.

Review Cycle 1 

Review Cycle 2 

  • Congestive Heart Failure (CHF)
  • Coronary artery disease (CAD)
  • Acute myocardial infarction (AMI)
  • Stroke
  • Diabetes
  • Cross-cutting/Non-condition specific
    (e.g., per capita-population)
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma
  • Pneumonia
  • Breast cancer
  • Colorectal cancer
  • Hip/Knee replacement
  • Hip/Pelvic fracture
  • Low back pain


The work of Phase II is being overseen by a Steering Committee. Four technical advisory panels (TAPs) offered clinical expert review of candidate measures. In accordance with the two review cycles, there were two calls for measures within the project, each for separate sets of conditions. Measures from both phases were be open for public and member comment and subsequent member voting. Candidate resource use measures are being considered for NQF endorsement as national voluntary consensus standards. Agreement will be developed through NQF’s Consensus Development Process (CDP, Version 1.8). This project is guided by a Steering Committee of representatives from across the spectrum of healthcare stakeholders that considers and makes recommendations regarding comments from healthcare stakeholders and existing NQF reports and prior work.


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

Related NQF Work

Contact Information

For further information, contact Ashlie Wilbon, RN, MPH 202-783-1300 or via e-mail at efficiency@qualityforum.org.

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