Table 1.

Instructions of the American Society of Breast Surgeons for ranking of quality measure domains

Ranking 42,43

1. [Evaluate the quality domains] for appropriateness (median ranking) and agreement (dispersion of rankings) to generate quality indicators

2. A measure [will be] considered valid if adherence with this measure is critical to provide quality care to patients with [breast cancer], regardless of cost or feasibility of implementation. Not providing the level of care addressed in the measure would be considered a breach in practice and an indication of unacceptable care

3. Validity rankings are based on the panelists’ own personal judgments and not on what they thought other experts believed

4. The measures should apply to the average patient who presents to the average physician at an average hospital

Importance criteria 57

1. Variation of care

2. Feasibility of measurement, without undue burden

3. Usability for accountability [public transparency or quality payment programs]

4. Applicability for quality improvement activity

Scoring criteria 42,43

1 = not valid

5 = uncertain/equivocal validity

9 = valid

Verbatim instructions from an American College of Surgeons ranking study43