quality measure
qlty_meas_cdDefinition
ISO-11179 Definition
A standardized metric used to assess and compare the clinical quality, patient safety, care coordination, patient experience, and population health outcomes delivered by healthcare providers and health plans. Quality measures translate clinical guidelines and evidence-based practices into quantifiable indicators that can be calculated from administrative claims data, electronic health records, or patient surveys. NCQA HEDIS contains over 90 quality measures used in Medicare Advantage Star Ratings and commercial health plan accreditation.
CMS Core Quality Measures Collaborative has aligned quality measures across payer programs to reduce provider reporting burden. Quality measures are classified as process measures tracking whether recommended care was delivered, outcome measures assessing patient health results, structural measures evaluating care infrastructure, and patient experience measures capturing member satisfaction. Healthcare data teams build quality measure calculation engines that identify eligible denominators from claims and enrollment data, capture numerator events from claims and supplemental clinical data, apply NCQA technical specifications, and produce auditable measure rates used in value based payment performance evaluation.
Standard Abbreviation
qlty_meas_cd
Category
Production DDL — FACT_QUALITY_MEASURE
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
qlty_key INTEGER NOT NULL -- surrogate key,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
plan_key INTEGER NOT NULL -- FK to DIM_PLAN,
meas_yr SMALLINT -- measurement year,
hedis_meas_cd VARCHAR(20) -- HEDIS measure code,
denom_ind CHAR(1) -- denominator eligible,
numer_ind CHAR(1) -- numerator met,
excl_ind CHAR(1) -- exclusion indicator,
gap_open_ind CHAR(1) -- care gap open,
star_rtg_nbr DECIMAL(3,1) -- star rating,
qlty_scr DECIMAL(5,2) -- quality score,
perf_thrsh_pct DECIMAL(5,2) -- performance threshold,
raf_scr DECIMAL(10,3) -- risk adjustment factor,
outreach_cnt SMALLINT -- outreach attempts,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →
Why This Term Matters
Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.
Related Content
Related Definitions
Looking for more healthcare terms?
Browse our complete library of 100,000+ standardized healthcare data terms
Browse All Terms