1. Module 4 Part 3 Operationalizing the Measures
Adapted from:
The Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), and the Health Resources and Services Administration (HRSA) Quality Toolkits

2. Objectives Discuss the operational definitions of a family of measures
Describe data sources for access to those measures

3. Creating Operational Definitions
Why are operational definitions important?

4. Operational Definitions
Operational definitions specify:
What data will be collected
When (the frequency of measurement)
How (using EHR, CRF, surveys, etc)
Agreement must be reached by team
Agreement must include:
Who will collect the data
Criteria for judgment of data quality
Missingness and proportion of eligible patients done

5. Choose & Operationalize Performance Measures
Include staff in the measure selection process
Choose performance measures with the following characteristics:
Align with your organization’s goals
Demonstrate a relationship to positive health outcomes
Under the control of the healthcare system
Reliable, valid, and standardized

6. Operational Definition
Example: Discharge Care Medication Measure
Criteria: Complete for all STEMI patients with stent at discharge.
Medication Reconciliation at discharge Process Measure: Address indication, action, dose, how to take
1= Yes; 0=No; U=Unknown; NA=NA (no points)
New medications were addressed?
Changes to home medications were addressed?
Deletions to home medications were addressed?
Continuation of home medications addressed?
Total score (total answered yes, no, or unknown (one for yes, or zero for no or unknown)
*Submit summary data each month on the 15th day, 6 weeks after the 30th day of the month. Example: January patients are due March 15
Criteria for use specified?
What, When, How to collect data for the measure?
Who will complete the data form or audit—agreed upon and clear?

7. Operational Definition
Example: Discharge Care Medication Measure
Data dictionary: Include additional details on the measure.
Medication Reconciliation at discharge Process Measure: Address indication, action, dose, how to take
What population: Inclusion/exclusion; numerator/denominator
What type of measure, improvement target specified?
Data element definition: ICD-9 vs ICD-10
Sampling specification? Analysis suggestions?
Risk adjustment; accuracy, data cleaning specified?
Reporting recommendations: Aggregate rate generated from count data and reported as a proportion

8. Example Comments
Electronic health records (EHRs) can be helpful in constructing and tracking quality measures
EHRs aid in quality improvement by improving clinical documentation and by making standardized patient data readily available for collection
EHRs are a source of detailed, current patient information for use in constructing performance measures

9. Summary Select an AIM Select measures for each AIM
Include a FAMILY of operational measures
Process
Outcome
Balancing / Structure
Operationalize definitions for each measure