PQA follows a systematic, transparent, and consensus-based process in the development and maintenance of measures. This process ensures that PQA measures are relevant and continue to support improvement in health care.
Previous blogs have focused on the early phases of the measure development lifecycle, including measure conceptualization, measure specification , measure testing and measure endorsement. More recently, we highlighted the measure maintenance process, ensuring that endorsed measures remain relevant, valuable and up-to-date with the most recent evidence and guidelines.
But what happens when a measure is no longer relevant or efforts to revise are greater than the benefits provided? In these cases, the measure may be a candidate for retirement. This blog will focus on the criteria and processes that PQA follows to identify, recommend and confirm measures proposed for retirement.
Review of Measures: Proposal to Retire
Measures may be identified as candidates for potential retirement during PQA maintenance, discussions with PQA members or input from the public. PQA staff then carefully consider the rationale for the proposed retirement of the measure, which may include, but is not limited to, the following criteria:
- Lack of measure use
- Current evidence, clinical guidelines or standards of practice no longer align with the original intent of the measure
- Another measure is available that better addresses the need or has greater applicability
- Measure performance rates are so high and unvarying that the measure no longer distinguishes good from poor quality
When a measure is selected for potential retirement consideration, PQA reaches out to licensees who have reported use of the measure to understand the potential impact of retirement and to identify methods to help minimize disruptions. Finally, PQA develops a recommendation for retirement consideration that includes supporting rationale, user feedback, advantages and disadvantages of retirement, and any potential impacts or unintended consequences that may be experienced due to retirement.
Engagement of PQA Expert Members: Measure Update Panel (MUP)
When a PQA measure is proposed for retirement consideration, the measure is presented to the Measure Update Panel (MUP). As discussed in the previous blog, the MUP is a panel responsible for evaluating potential updates to measures and considering measure retirement. MUP members have experience, including leadership roles, in PQA measure development groups and are selected by PQA staff through an annual self-nomination process.
The MUP reviews the retirement recommendation and carefully evaluates the supporting rationale. After discussion and review of the materials, each MUP member votes to support or not support retirement consideration of the measure. Pending a greater than 60% vote in support of retirement consideration, the measure then moves to the Quality Metrics Expert Panel (QMEP) for review and vote.
Engagement of PQA Expert Members: Quality Metrics Expert Panel (QMEP)
Once the MUP approves measures for retirement consideration, the Quality Metrics Expert Panel (QMEP) reviews measures for approval. As discussed in previous blogs, the QMEP is a panel composed of PQA members with expertise in measurement science, clinical practice, data analytics, quality improvement and measure use. QMEP members have extensive experience serving on PQA-convened measurement groups and are selected by PQA staff through an annual self-nomination process.
After review and discussion, the QMEP votes on whether the measure should be considered for retirement by membership. Pending a greater than 60% QMEP vote in support, the measure moves forward for full PQA membership consideration and vote.
Engaging the Full PQA Membership
Once approved by the MUP and QMEP, the full PQA membership is given the opportunity to review and provide feedback on measures proposed for retirement through a public comment period. PQA provides measure-specific information that includes an overview of the measure specifications, rationale and key considerations for retirement. The public comment period is open for 15 business days.
Once the comment period closes, PQA publishes the comments to the Member Resource Library and hosts an all-member webinar to review key points supporting retirement consideration and to address comments. Following the webinar, PQA member organizations are provided the opportunity to cast one vote on the measure(s) proposed for retirement.
A greater than 60% vote in support is required for a measure to be retired. If the measure is retired, a notice is sent to users of the measure.
Involvement Now and in the Future
You have the opportunity to be involved! During the current comment period you can review the four measures proposed for retirement consideration and provide feedback. For more information, see our October 3 email.
Members also are encouraged to join in the all-member webinar on December 2, 2022. Registration information for the webinar can be found in the Member Resource Library.
PQA is also requesting self-nominations from members to serve on the QMEP and MUP until October 28.