Table.

Twelve attributes and ideal descriptions of quality measures, with examples from United Kingdom

Attribute	Ideal description	Measures with attribute	Measures without attribute
Valid	Health professions, managers, and public see meeting the quality measure as better quality (better patient outcomes; more efficient and patient friendly services, etc)	Waiting times; death rates from surgery; readmission rates; complaints and litigation; significant event auditing	Singlehanded general practice
Communicable	Relevance of measure can be easily explained and understood by target groups	Prevention uptake rates (for example, cervical cytology or immunisation)	Star rating of NHS trusts
Effective	It measures what it purports to measure—so useful for clinicians, public, and managers in making choices and commissioning services; free of perverse incentives	Commission for Health Improvement reports	Waiting times; day surgery rates; revalidation
Reliable	Data should be complete, accurate, consistent, and reproducible	Singlehanded general practice	Fellowship by assessment; availability of general practitioner for consultation
Objective	Data should be as independent of subjective judgment as possible	Prescribing data	NHS doctor appraisal; Commission for Health Improvement reports
Available	Data should be collected for routine clinical or organisational reasons or be available quickly with minimum of extra effort and cost	Prescribing data; star rating of NHS trusts	Long term effects of care; functional status; link between care and outcome
Contextual	Measure should be context free or important context effects should be adjusted for	Consultant numbers per 1000 patients with disease	Prevention uptake rates
Attributable	How well measure reflects quality of individuals, teams, or organisations must be explicit; measure to be used appropriately in its presentation and interpretation	NHS doctor appraisal; revalidation; fellowship or membership by assessment; quality team development; quality practice award	Waiting times; overall patient satisfaction
Interpretation	How well measure reflects health needs, capacity, structures, or performance should be explicit	Bed occupancy	General practitioners' referral rates; prescribing data (PACT)
Comparable	Where “gold standard” (for example, NICE guideline, NSF standard or GMC guidance) exists, measure should allow reliable comparison with standard; otherwise comparison should be to other data in similar circumstances	Thrombolysis in myocardial infarction; aspirin in ischaemic heart disease or stroke; glycaemic and blood pressure control in diabetes	General practitioners' referral rates
Remediable	Need for recognised, accepted, and feasible methods for influencing measure and improving quality, need for resources for intervening; change can be achieved if it is needed	Record keeping	Effects due to deprivation and lifestyle (acute myocardial infarction, smoking rates, obesity); attendance rates at accident and emergency; suicide rates
Repeatable	Measure should be sensitive to improvement over time	Staffing levels; bed numbers and occupancy	Complaints and litigation; significant event auditing

NICE=National Institute for Clinical Excellence; NSF=national service framework; GMC=General Medical Council.