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14.17 Resource Measure - Content

Clinical Quality Information icon Work GroupMaturity Level: 4 Trial UseSecurity Category: Anonymous Compartments: No defined compartments

The Measure resource provides the definition of a quality measure.

14.17.1 Scope and Usage

The Measure resource represents a structured, computable definition of a health-related measure such as a clinical quality measure, public health indicator, or population analytics measure. A quality measure is a quantitative tool to assess the performance of an individual or organization with respect to a specified process or outcome via the measurement of actions, processes, or outcomes of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.

Note that the Measure itself does not typically contain any logic; rather a Library resource is referenced that contains the logic required by the measure, and the various expression elements, such as population criteria, reference named expressions within that library (or libraries). In addition, if the Measure references multiple libraries, then any expression references within the resource must be qualified with the name of the library that contains the referenced expression.

This resource is a definition resource from a FHIR workflow perspective - see Workflow, specifically Definition.

For a detailed discussion of how to use the Measure and MeasureReport resources, refer to the Quality Reporting topic.

14.17.2 Boundaries and Relationships

The Measure resource describes a specific quality measure, or population analytic, providing the structure of the measure in terms of the calculation elements (the populations involved). The Group resource is also capable of describing a population, however, the complexity involved in specifying the criteria in the general case requires the use of a high-level query language such as Clinical Quality Language (CQL). As such, the Measure resource defines only the top-level populations and references expressions for the actual criteria. These expressions are typically provided using a Library resource containing CQL or ELM expressions. In addition, the individual members of a population may be cases such as encounters or procedures and in these cases, the Group resource would be unable to represent the population characteristics accurately.

A Measure is also similar to an ObservationDefinition resource, in that it is purely definitional, it contains no actual measurements, only a description of how to calculate a particular measurement or set of measurements. Measure is different from ObservationDefinition in that Measure is intended to provide a computable specification.

A Measure is also similar to a clinical document, but as with the relationship to Observation, a Document is specific to a particular subject.

14.17.3 References to this Resource

14.17.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure TU DomainResource A quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
+ Rule: Stratifier SHALL be either a single criteria or a set of criteria components

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
Interfaces Implemented: MetadataResource
... url ΣC 0..1 uri Canonical identifier for this measure, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
... identifier Σ 0..* Identifier Additional identifier for the measure

... version Σ 0..1 string Business version of the measure
... versionAlgorithm[x] Σ 0..1 How to compare versions
Binding: Version Algorithm (Extensible)
.... versionAlgorithmString string
.... versionAlgorithmCoding Coding
... name ΣC 0..1 string Name for this measure (computer friendly)
... title ΣT 0..1 string Name for this measure (human friendly)
... subtitle T 0..1 string Subordinate title of the measure
... status ?!Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (Required)
... experimental Σ 0..1 boolean For testing only - never for real usage
... subject[x] 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: Participant Resource Types (Extensible)
.... subjectCodeableConcept CodeableConcept
.... subjectReference Reference(Group)
... basis Σ 0..1 code Population basis
Binding: All FHIR Types (Required)
... date Σ 0..1 dateTime Date last changed
... publisher ΣT 0..1 string Name of the publisher/steward (organization or individual)
... contact Σ 0..* ContactDetail Contact details for the publisher

... description ΣT 0..1 markdown Natural language description of the measure
... useContext Σ 0..* UsageContext The context that the content is intended to support

... jurisdiction ΣXD 0..* CodeableConcept Intended jurisdiction for measure (if applicable)
Binding: Jurisdiction ValueSet (Extensible)

... purpose T 0..1 markdown Why this measure is defined
... usage T 0..1 markdown Describes the clinical usage of the measure
... copyright T 0..1 markdown Use and/or publishing restrictions
... copyrightLabel T 0..1 string Copyright holder and year(s)
... approvalDate 0..1 date When the measure was approved by publisher
... lastReviewDate 0..1 date When the measure was last reviewed by the publisher
... effectivePeriod Σ 0..1 Period When the measure is expected to be used
... topic XD 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc
Binding: Definition Topic (Example)

... author 0..* ContactDetail Who authored the content

... editor 0..* ContactDetail Who edited the content

... reviewer 0..* ContactDetail Who reviewed the content

... endorser 0..* ContactDetail Who endorsed the content

... relatedArtifact 0..* RelatedArtifact Additional documentation, citations, etc

... library 0..* canonical(Library) Logic used by the measure

... disclaimer Σ 0..1 markdown Disclaimer for use of the measure or its referenced content
... scoring Σ 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort
Binding: Measure Scoring icon (Extensible)
... scoringUnit Σ 0..1 CodeableConcept What units?
Binding: Measure Scoring Unit (Example)
... compositeScoring Σ 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted
Binding: Composite Measure Scoring (Extensible)
... type Σ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite
Binding: Measure Type (Extensible)

... riskAdjustment Σ 0..1 markdown How risk adjustment is applied for this measure
... rateAggregation Σ 0..1 markdown How is rate aggregation performed for this measure
... rationale Σ 0..1 markdown Detailed description of why the measure exists
... clinicalRecommendationStatement Σ 0..1 markdown Summary of clinical guidelines
... improvementNotation Σ 0..1 CodeableConcept increase | decrease
Binding: Measure Improvement Notation (Required)
... term 0..* BackboneElement Defined terms used in the measure documentation

.... code 0..1 CodeableConcept What term?
Binding: Measure Definition Example (Example)
.... definition 0..1 markdown Meaning of the term
... guidance ΣXD 0..1 markdown Additional guidance for implementers (deprecated)
... group C 0..* BackboneElement Population criteria group

.... linkId C 0..1 string Unique id for group in measure
+ Warning: Link ids should be 255 characters or less
.... code 0..1 CodeableConcept Meaning of the group
Binding: Measure Group Example (Example)
.... description 0..1 markdown Summary description
.... type Σ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite
Binding: Measure Type (Extensible)

.... subject[x] 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: Participant Resource Types (Extensible)
..... subjectCodeableConcept CodeableConcept
..... subjectReference Reference(Group)
.... basis Σ 0..1 code Population basis
Binding: All FHIR Types (Required)
.... scoring Σ 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort
Binding: Measure Scoring icon (Extensible)
.... scoringUnit Σ 0..1 CodeableConcept What units?
Binding: Measure Scoring Unit (Example)
.... rateAggregation Σ 0..1 markdown How is rate aggregation performed for this measure
.... improvementNotation Σ 0..1 CodeableConcept increase | decrease
Binding: Measure Improvement Notation (Required)
.... library 0..* canonical(Library) Logic used by the measure group

.... population 0..* BackboneElement Population criteria

..... linkId C 0..1 string Unique id for population in measure
+ Warning: Link ids should be 255 characters or less
..... code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: Measure Population Type (Extensible)
..... description 0..1 markdown The human readable description of this population criteria
..... criteria 0..1 Expression The criteria that defines this population
..... groupDefinition 0..1 Reference(Group) A group resource that defines this population
..... inputPopulationId 0..1 string Which population
..... aggregateMethod 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
Binding: Measure Aggregate Method (Extensible)
.... stratifier C 0..* BackboneElement Stratifier criteria for the measure

..... linkId C 0..1 string Unique id for stratifier in measure
+ Warning: Link ids should be 255 characters or less
..... code C 0..1 CodeableConcept Meaning of the stratifier
Binding: Measure Stratifier Example (Example)
..... description C 0..1 markdown The human readable description of this stratifier
..... criteria C 0..1 Expression How the measure should be stratified
..... groupDefinition 0..1 Reference(Group) A group resource that defines this population
..... component C 0..* BackboneElement Stratifier criteria component for the measure

...... linkId C 0..1 string Unique id for stratifier component in measure
+ Warning: Link ids should be 255 characters or less
...... code 0..1 CodeableConcept Meaning of the stratifier component
Binding: Measure Stratifier Example (Example)
...... description 0..1 markdown The human readable description of this stratifier component
...... criteria 0..1 Expression Component of how the measure should be stratified
...... groupDefinition 0..1 Reference(Group) A group resource that defines this population
... supplementalData 0..* BackboneElement What other data should be reported with the measure

.... linkId C 0..1 string Unique id for supplementalData in measure
+ Warning: Link ids should be 255 characters or less
.... code 0..1 CodeableConcept Meaning of the supplemental data
Binding: Measure Supplemental Data Example (Example)
.... usage 0..* CodeableConcept supplemental-data | risk-adjustment-factor
Binding: Measure Data Usage (Extensible)

.... description 0..1 markdown The human readable description of this supplemental data
.... criteria 1..1 Expression Expression describing additional data to be reported

doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) , the spreadsheet version & the dependency analysis

14.17.4.1 Terminology Bindings

Path ValueSet Type Documentation
Measure.versionAlgorithm[x] VersionAlgorithm Extensible

Indicates the mechanism used to compare versions to determine which is more current.
Measure.status PublicationStatus Required

The lifecycle status of an artifact.
Measure.subject[x] ParticipantResourceTypes Extensible

All Resource Types that represent participant resources
Measure.basis FHIRTypes (a valid code from All FHIR Types) Required

All FHIR types
Measure.jurisdiction JurisdictionValueSet Extensible

This value set defines a base set of codes for country, country subdivision and region for indicating where a resource is intended to be used.

Note: The codes for countries and country subdivisions are taken from ISO 3166 icon while the codes for "supra-national" regions are from UN Standard country or area codes for statistical use (M49) icon.
Measure.topic DefinitionTopic Example

High-level categorization of the definition, used for searching, sorting, and filtering.
Measure.scoring MeasureScoring icon Extensible

The scoring type of the measure.
Measure.scoringUnit MeasureScoringUnit Example

This is an example value set illustrating some typical scoring units used in quality measure specifications.
Measure.compositeScoring CompositeMeasureScoring Extensible

The composite scoring method of the measure.
Measure.type MeasureType Extensible

The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).
Measure.improvementNotation MeasureImprovementNotation Required

Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
Measure.term.code MeasureDefinitionExample Example

Example Measure Definitions for the Measure Resource.
Measure.group.code MeasureGroupExample Example

Example Measure Groups for the Measure Resource.
Measure.group.type MeasureType Extensible

The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).
Measure.group.subject[x] ParticipantResourceTypes Extensible

All Resource Types that represent participant resources
Measure.group.basis FHIRTypes (a valid code from All FHIR Types) Required

All FHIR types
Measure.group.scoring MeasureScoring icon Extensible

The scoring type of the measure.
Measure.group.scoringUnit MeasureScoringUnit Example

This is an example value set illustrating some typical scoring units used in quality measure specifications.
Measure.group.improvementNotation MeasureImprovementNotation Required

Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
Measure.group.population.code MeasurePopulationType Extensible

The type of population.
Measure.group.population.aggregateMethod MeasureAggregateMethod Extensible

Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
Measure.group.stratifier.code MeasureStratifierExample Example

Identifier subgroups in a population for measuring purposes.
Measure.group.stratifier.component.code MeasureStratifierExample Example

Identifier subgroups in a population for measuring purposes.
Measure.supplementalData.code MeasureSupplementalDataExample Example

Supplemental data in a population for measuring purposes.
Measure.supplementalData.usage MeasureDataUsage Extensible

The intended usage for supplemental data elements in the measure.

14.17.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img cnl-0Warning (base)Name should be usable as an identifier for the module by machine processing applications such as code generationname.exists() implies name.matches('^[A-Z]([A-Za-z0-9_]){1,254}$')
img mea-1Rule (base)Stratifier SHALL be either a single criteria or a set of criteria componentsgroup.stratifier.all((code | description | criteria).exists() xor component.exists())
img cnl-1Warning Measure.urlURL should not contain | or # - these characters make processing canonical references problematicexists() implies matches('^[^|# ]+$')
img mea-2Warning Measure.group.linkIdLink ids should be 255 characters or less$this.length() <= 255
img mea-3Warning Measure.group.population.linkIdLink ids should be 255 characters or less$this.length() <= 255
img mea-4Warning Measure.group.stratifier.linkIdLink ids should be 255 characters or less$this.length() <= 255
img mea-5Warning Measure.group.stratifier.component.linkIdLink ids should be 255 characters or less$this.length() <= 255
img mea-6Warning Measure.supplementalData.linkIdLink ids should be 255 characters or less$this.length() <= 255

14.17.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
composed-of reference What resource is being referenced Measure.relatedArtifact.where(type='composed-of').resource
(Any)		 6 Resources
context token A use context assigned to the measure (Measure.useContext.value.ofType(CodeableConcept)) 30 Resources
context-quantity quantity A quantity- or range-valued use context assigned to the measure (Measure.useContext.value.ofType(Quantity)) | (Measure.useContext.value.ofType(Range)) 30 Resources
context-type token A type of use context assigned to the measure Measure.useContext.code 30 Resources
context-type-quantity composite A use context type and quantity- or range-based value assigned to the measure On Measure.useContext:
  context-type: code
  context-quantity: value.ofType(Quantity) | value.ofType(Range)		 30 Resources
context-type-value composite A use context type and value assigned to the measure On Measure.useContext:
  context-type: code
  context: value.ofType(CodeableConcept)		 30 Resources
date date The measure publication date Measure.date 31 Resources
depends-on reference What resource is being referenced Measure.relatedArtifact.where(type='depends-on').resource | Measure.library
(Library, Any)		 6 Resources
derived-from reference What resource is being referenced Measure.relatedArtifact.where(type='derived-from').resource
(Any)		 10 Resources
description string The description of the measure Measure.description 29 Resources
effective date The time during which the measure is intended to be in use Measure.effectivePeriod 12 Resources
identifier token External identifier for the measure Measure.identifier 35 Resources
jurisdiction token Intended jurisdiction for the measure Measure.jurisdiction 27 Resources
name string Computationally friendly name of the measure Measure.name 28 Resources
predecessor reference What resource is being referenced Measure.relatedArtifact.where(type='predecessor').resource
(Any)		 10 Resources
publisher string Name of the publisher of the measure Measure.publisher 31 Resources
status token The current status of the measure Measure.status 35 Resources
successor reference What resource is being referenced Measure.relatedArtifact.where(type='successor').resource
(Any)		 6 Resources
title string The human-friendly name of the measure Measure.title 28 Resources
topic token Topics associated with the measure Measure.topic 10 Resources
url uri The uri that identifies the measure Measure.url 34 Resources
version token The business version of the measure Measure.version 32 Resources