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  1. FHIR Specification Feedback
  2. FHIR-42826

Clarify ratio measure Numerator definition

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Quality Measures (FHIR)
    • 4.0.0
    • Clinical Quality Information
    • Glossary
      QMs
    • 3.4.4 Ratio Measures
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      Agree and will update accordingly (note: if UTG tracker is not approved in time for ballot, changes b, c, and d below can still be implemented)

      A. Open UTG tracker to change definition of Numerator to state:

      The numerator statement describes the process, condition, event, or outcome that satisfies the measure’s focus or intent. The numerator statement includes parameters such as:

      • the Event or events that will satisfy the numerator inclusion criteria
      • the Performance period or time interval in which the numerator event must occur, if it is different from that used for identifying the denominator.

      Source: https://mmshub.cms.gov/measure-lifecycle/measure-specification/develop-specification/numerator 

      Once UTG tracker is approved and implemented, reflect change into the QMIG:

      B. Table 3-4: Population Criteria Definitions for Ratio Measures

      Change Numerator definition to: The outcomes expected for each entity defined in the Denominator Initial Population of a Proportion or Ratio measure.

      C. Glossary: http://build.fhir.org/ig/HL7/cqf-measures/glossary.html#numerator

      Change section 12.1.14 Numerator to state:

      Numerator criteria define the patients, subjects, or events that should be included in the upper portion of a fraction used to calculate a rate, proportion, or ratio. Also called the measure focus, it is the target process, condition, event, or outcome. 

      Numerator criteria are the processes or outcomes expected for each patient, subject, or event defined in the denominator (for rate and proportion measures) or initial population (for ratio measures). A numerator statement describes the clinical action that satisfies the conditions of the measure. 

      D. Table 3-3: Population Criteria Definitions for Proportion Measures

      http://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#proportion-measures

      Change Numerator definition to: 

      Numerator criteria define the patients, subjects, or events that should be included in the upper portion of a fraction used to calculate a rate, proportion, or ratio measure. Also called the measure focus, it is the target process, condition, event, or outcome. Numerator criteria are the processes or outcomes expected for each patient, subject, or event defined in the denominator. A numerator statement describes the clinical action that satisfies the conditions of the measure.

       

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      Agree and will update accordingly (note: if UTG tracker is not approved in time for ballot, changes b, c, and d below can still be implemented) A. Open UTG tracker to change definition of Numerator to state: The numerator statement describes the process, condition, event, or outcome that satisfies the measure’s focus or intent. The numerator statement includes parameters such as: the Event or events that will satisfy the numerator inclusion criteria the Performance period or time interval in which the numerator event must occur, if it is different from that used for identifying the denominator. Source: https://mmshub.cms.gov/measure-lifecycle/measure-specification/develop-specification/numerator   Once UTG tracker is approved and implemented, reflect change into the QMIG: B. Table 3-4: Population Criteria Definitions for Ratio Measures Change Numerator definition to : The outcomes expected for each entity defined in the Denominator Initial Population of a Proportion or Ratio measure. C. Glossary: http://build.fhir.org/ig/HL7/cqf-measures/glossary.html#numerator Change section 12.1.14 Numerator to state: Numerator criteria define the patients, subjects, or events that should be included in the upper portion of a fraction used to calculate a rate, proportion, or ratio . Also called the measure focus, it is the target process, condition, event, or outcome.   Numerator criteria are the processes or outcomes expected for each patient, subject, or event defined in the denominator (for rate and proportion measures) or initial population (for ratio measures) . A numerator statement describes the clinical action that satisfies the conditions of the measure.   D. Table 3-3: Population Criteria Definitions for Proportion Measures http://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#proportion-measures Change Numerator definition to :   Numerator criteria define the patients, subjects, or events that should be included in the upper portion of a fraction used to calculate a rate, proportion , or ratio   measure . Also called the measure focus, it is the target process, condition, event, or outcome. Numerator criteria are the processes or outcomes expected for each patient, subject, or event defined in the denominator. A numerator statement describes the clinical action that satisfies the conditions of the measure.  
    • Yan Heras/ Peter Muir: 21-0-1
    • Clarification
    • Non-substantive

    Description

      Ratio measure Numerator is defined as a subset of Initial Population, however, there are a couple places in the IG, the wording of Numerator definition is not quite right and needs to be updated for clarity. 

      • Table 3-4: Population Criteria Definitions for Ratio Measures

      Numerator: The outcomes expected for each entity defined in the Denominator of a Proportion or Ratio measure.

      This definition could possibly mislead people to think that Numerator in a ratio measure is a subset of Denominator. 

      Numerator criteria define the patients, subjects, or events that should be included in the upper portion of a fraction used to calculate a rate, proportion, or ratio. Also called the measure focus, it is the target process, condition, event, or outcome. Numerator criteria are the processes or outcomes expected for each patient, subject, or event defined in the denominator. A numerator statement describes the clinical action that satisfies the conditions of the measure.

      Because the first sentence of the Numerator definition on the Glossary page includes "ratio" measure, so the sentence in red could mislead people to think the Numerator is a subset of Denominator even for a ratio measure. 

      • Table 3-3: Population Criteria Definitions for Proportion Measures

      http://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#proportion-measures

      The Numerator definition listed in Table 3-3 is the exact same as what's shown in the Glossary as mentioned above.  Since Table 3-3 is specifically for Proportion Measures, suggest not to mix ratio measure into the Numerator definition when listed in this table.

      Note that the Numerator definition in the measure population value set has the same issue. https://build.fhir.org/valueset-measure-population.html

       

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            abdullah.rafiqi Abdullah Rafiqi
            yanheras Yan Heras
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