• Alan Drabkin, Ronald N Adler, Wayne Altman, Alan M Ehrlich, Alicia Agnoli, and Brian S Alper.
• From Tufts University School of Medicine (AD, WA); Harvard Medical School (AD); University of Massachusetts Medical School (RA, AME); University of California Davis School of Medicine (AA); and Computable Publishing, Ipswich, MA (BSA). drabkin.alan@gmail.com.
• J Am Board Fam Med. 2022 Mar 1; 35 (2): 427-434.

IntroductionImproving design, selection and implementation of appropriate clinical quality measures can reduce harms and costs of health care and improve the quality and experience of care delivery. These measures have not been evaluated for appropriateness for use in performance measurement in a systematic, reproducible, and widely accepted manner.MethodsWe defined 10 criteria for evaluation of measure appropriateness in 4 domains: Patient-centeredness of outcomes, specification of population measured and measure detail, reliable evidence that benefits likely outweigh harms, and independence from significant confounders. We applied these criteria to 24 measures under consideration for statewide use in Massachusetts in public and private incentive-based programs. We appraised each measure as Appropriate or Not Appropriate for such use.ResultsWe rated 15 measures as Appropriate (62.5%). Three measures (12.5%) were considered Appropriate only if applied at a system level but not for patient-provider assessment and 6 measures (25%) were rated Not Appropriate. Reasons for designation as "Not Appropriate" included benefits not clearly outweighing harms, lack of preservation of patient autonomy, inappropriate specification of population and measure detail, confounding by locus of control, and confounding by social determinants of health.ConclusionsUsing this consensus-driven, 10-criteria methodology we were able to evaluate appropriateness of clinical quality measures. This methodology may improve measure design and inform selection of the most appropriate measures for use in quality measurement, financial incentives, and reporting.© Copyright 2022 by the American Board of Family Medicine.

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