Developing a clinical performance measure.
BACKGROUND
Clinical performance measurement is an increasingly important way for public and private purchasers alike to compare the value of health services provided by competing health delivery systems. The widespread use of performance measures has increased the demand for development of new measures that cover previously unevaluated aspects of care.


METHODS
Four steps required to develop a clinical performance measure that is suitable for making comparisons among health delivery systems are discussed: (1) choosing clinical areas to measure, (2) selecting performance indicators within each area, (3) designing specifications for consistent implementation of a measure, and (4) evaluating the scientific strength of a measure.


RESULTS
The application of these steps to developing measures of quality for hypertension is provided, with an emphasis on a measure of adequacy of control of blood pressure.


CONCLUSIONS
Developing useful clinical performance measures requires careful attention to methodologic issues. Following the steps outlined in this paper should enhance the quality of future measurement development.
McGlynn
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EA
Center for Research on Quality in Health Care, RAND Health, Health Services Research and Development, West Los Angeles Veterans Administration and Health Program, Santa Monica, CA 90401, USA.
Asch
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SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000145:classification; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D016730:Program Development; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index; D014481:United States