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Facts about accountability measures

December 10, 2014

The Joint Commission categorizes its process performance measures into accountability and non-accountability measures. This approach places more emphasis on an organization’s performance on accountability measures – quality measures that meet four criteria designed to identify measures that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement:

Research: Strong scientific evidence demonstrates that performing the evidence-based care process improves health outcomes (either directly or by reducing risk of adverse outcomes).

Proximity: Performing the care process is closely connected to the patient outcome; there are relatively few clinical processes that occur after the one that is measured and before the improved outcome occurs.

Accuracy: The measure accurately assesses whether or not the care process has actually been provided. That is, the measure should be capable of indicating whether the process has been delivered with sufficient effectiveness to make improved outcomes likely.

Adverse Effects: Implementing the measure has little or no chance of inducing unintended adverse consequences.

Measures that meet all four criteria should be used for purposes of accountability (e.g., for accreditation, public reporting, or pay-for-performance). Those measures that have not been designated as accountability measures may be useful for quality improvement, exploration and learning within individual health care organizations, and are good advice in terms of appropriate patient care. Going forward, The Joint Commission will have a primary focus on adopting accountability measures for its ORYX program. The Joint Commission will continue to re-examine all process (i.e., proportion and ratio) measures categorized as accountability measures to ensure they continue to meet the accountability criteria.

Focus on accountability measures

  • Launched in September 2011, The Joint Commission’s Top Performer on Key Quality Measures® program recognizes accredited hospitals that attain excellence on accountability measure performance.

  • The Joint Commission provides a Core Measure Solution Exchange®, which promotes the sharing of success stories among hospitals about performance measures, including accountability measures.

  • In 2012, Joint Commission accredited hospitals (not critical access hospitals) were required to meet a new performance improvement requirement (standard PI.02.01.03 element of performance 1) that established compliance with an 85 percent composite target rate for performance on ORYX accountability measures. Effective 2015, this standard will be temporarily suspended. Beginning in 2015, hospitals will have more flexibility in selecting ORYX measure sets and the method for submitting measurement data to The Joint Commission (i.e., chart-based measure data, electronic clinical quality measures (eCQMs), or a combination of both). Due to these various methods of data submission, the data will no longer have the same level of comparability and will not support calculation of the composite. It is anticipated that the standard will be modified and reinstated at a future date. Read more about the reporting options for ORYX performance measures for 2015.

For more about accountability measures

Read “Accountability Measures: Using Measurement to Promote Quality Improvement,” in the June 23, 2010 online issue of the New England Journal of Medicine, for which Mark R. Chassin, M.D., FACP, M.P.P, M.P.H., president and chief executive officer of The Joint Commission, was the lead author.