Domain Framework

The National Quality Measures Clearinghouse (NQMC) is a database of measures meeting specific criteria for inclusion. Measures in NQMC are classified into domains according to the domain framework below.

There are many dimensions of performance related to clinical health care delivery and population health within which measures can be developed. The classification of measures into domains within NQMC is based on a number of rationales:

Keep the organization of measures consistent with historical conventions, and extend those conventions
Clarify the purpose and use of measures for developers and users
Simplify search and retrieval of measures within the NQMC
Accommodate the expanding range of measure types over time, beyond the common focus on Process, Outcome, Access and Structure

Health care delivery measures are used to assess the performance of individual clinicians, clinical delivery teams, delivery organizations, or health insurance plans in the provision of care to their patients or enrollees. Population health measures are applied to groups of persons identified by geographic location, organizational affiliation or non-clinical characteristics, in order to assess public health programs, community influences on health, or population-level health characteristics that may not be directly attributable to the care delivery system.

The classification of domains that appears below relies on a concept of criterion of quality that differentiates quality measures from related measures. In practical terms, the criterion of quality determines whether a higher or lower score for a measure indicates better care. That is, if two results derived using the same measure differ then the measure's supporting evidence must indicate whether the higher of the two results represents better or worse quality than the lower result. The type of evidence on which this criterion is based varies by domain as described in the definitions below.

Health care delivery measures and population health measures can each be classified into three parallel sub-groups: quality measures, related measures and efficiency measures. By definition, clinical and population health quality measures incorporate a criterion of quality, which differs by domain as described in the definitions below. Related health care and population health measures describe other activities or characteristics that are not supported by evidence regarding quality of care. Efficiency measures include both a quality component and a cost component.

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