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Kahn JM, Gould MK, Krishnan JA, Wilson KC, Au DH, Cooke CR, Douglas IS, Feemster LC, Mularski RA, Slatore CG, Wiener RS, ATS Ad Hoc Committee on the Development of Performance Measures from ATS Guidelines. An official American thoracic society workshop report: developing performance measures from clinical practice guidelines. Annals of the American Thoracic Society. 2014 May 1; 11(4):S186-95.
Many health care performance measures are either not based on high-quality clinical evidence or not tightly linked to patient-centered outcomes, limiting their usefulness in quality improvement. In this report we summarize the proceedings of an American Thoracic Society workshop convened to address this problem by reviewing current approaches to performance measure development and creating a framework for developing high-quality performance measures by basing them directly on recommendations from well-constructed clinical practice guidelines. Workshop participants concluded that ideally performance measures addressing care processes should be linked to clinical practice guidelines that explicitly rate the quality of evidence and the strength of recommendations, such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. Under this framework, process-based performance measures would only be developed from strong recommendations based on high- or moderate-quality evidence. This approach would help ensure that clinical processes specified in performance measures are both of clear benefit to patients and supported by strong evidence. Although this approach may result in fewer performance measures, it would substantially increase the likelihood that quality-improvement programs based on these measures actually improve patient care.