Purpose: To propose an approach to the evaluation of the utility of an outcome measure for use in making comparisons among health plans, hospitals, networks, or other accountable entities.
Method: Seven components are recommended for evaluation: whether the outcome is a health outcome; the extent to which expectations for performance can be defined; the role medical care plays in achieving the outcome; the relative complexity of events that produce the outcome; the degree to which attribution can reasonably be made; the suitability of risk adjustment for limiting external sources of variation; and the likelihood that the measure provides perverse behavioral incentives.
Results: Illustrative examples are given in each area for scoring the performance of measures on the component.
Conclusion: Outcomes measurement is of great interest to a variety of potential users. The approach proposed here is intended to provoke discussion and more rigorous development of tools that will help to identify the measures that are likely to produce the most useful information for making comparisons among accountable entities in the health system.