NQF Statement on Measure Utilization During COVID-19 

National Quality Forum (NQF) recognizes the unprecedented situation and challenges that the COVID-19 pandemic has caused for measure developers and end-users. While quality measures still need to be statistically valid and reliable, the potential problems affecting quality measurement, in most cases, may go beyond reliability and validity and could include case-mix adjustment and other elements of measure specification and interpretation. For example, only the most urgent hip/knee surgical cases were done during the temporary suspension of elective services, so any hip/knee measure would have to be interpreted in light of a different case mix, not just a smaller sample size.

As NQF usually does not review how an endorsed measure is implemented or used beyond annual maintenance or re-endorsement, we encourage end-users to work closely with measure developers as well as measure stewards to think through the best measure adjustment strategies for their specific measure of interest. This may include simply not using a measure until the COVID-19 pandemic has passed, and the clinical care environment has returned to normal.

If a NQF-endorsed measure is being used for public reporting, payment, or quality improvement purposes, we recommend that measure developers and end-users carefully weigh all potential options in order to minimize the impact of any proposed specification changes on the reliability, validity, and adequacy of risk adjustment. For example, if one considers removing January 2020 to June 2020 performance period data from a measure, it is critical to ensure the measure is valid and reliable without utilizing data from that timeframe. If so, it could be a viable option to temporarily amend a measure by excluding the aforementioned time period. However, it is unlikely all relevant dynamics of the care process for any measure had returned to normal as of July 2020 so measure stewards and users should consider the effects of the ongoing COVID-19 situation that may continue to inadvertently impact care process and data element variables as well. Another potential option could be extending a measure's "look-back" period to enhance the sample size, but the measure then is capturing performance of that earlier time period and not the 2020 time period. These factors should be considered and analyzed when considering adjustments to measures.

NQF does not intend to review any temporary changes to measure specifications in 2020, but does strongly encourage measure developers, stewards, and end-users to take the above-mentioned considerations into account and conduct corresponding statistical analyses. We will provide more guidance, if needed, as the situation evolves. 

About National Quality Forum
The National Quality Forum (NQF) works with members of the healthcare community to drive measurable health improvements together. NQF is a not-for-profit, membership-based organization that gives all healthcare stakeholders a voice in advancing quality measures and improvement strategies that lead to better outcomes and greater value. Learn more at www.qualityforum.org.