The specific Joint Commission certification measure set to which a measure belongs (e.g., health care staffing services).
A unique alpha-numeric identifier assigned to a measure. Information associated with a measure is identified by this unique alpha-numeric number.
A brief title that uniquely identifies the measure.
A brief explanation of the measure's focus, such as the activity or the area on which the measure centers attention (e.g., do not return, personnel file audit).
An explanation that states why it is important to receive data/information on this measure. This may include specific literature references, evidence based information, expert consensus, etc.
Represents the portion of the denominator population that satisfies the conditions of the performance measure to be an indicator event.
Included Population in Numerator Specific information describing the population(s) comprising the numerator, not contained in the numerator statement, or not applicable. Excluded Population in Numerator Specific information describing the population(s) that should not be included in the numerator, or none. Data Elements Those data elements necessary or required to determine (or establish) the numerator.Represents the population evaluated by the performance measure.
Included Population in Denominator Specific information describing the population(s) comprising the denominator, not contained in the denominator statement or not applicable. Excluded Population in Denominator Specific information describing the population(s) that should not be included in the denominator, or none. Data Elements Those data elements required to determine (or establish) the denominator.Recommendations to reduce identifiable data errors, to the extent possible.
Recommendations to assist in the process of interpreting data and drawing valid conclusions.
Indicates whether a measure is amenable to selecting a random subset of a population in order to estimate the organization's performance level without collecting data for the entire population.
A description of the steps or statistical calculations (computations) used to derive the numerator and denominator or continuous variable values required for a measure. Measure Information Forms in this manual will include either an algorithm or calculation model.
Specific literature references that are used to support the importance of the performance measure.
Each measure is described by a unique algorithm. An algorithm is a predefined set of rules that help to break down complex processes into simple, repetitive steps.
Measure algorithms serve two purposes. First, they evaluate and identify missing and/or invalid data that will prohibit the ability to properly evaluate the measure. Second, they determine if:Symbol | Explanation |
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Start/Stop denotes the beginning or end of an algorithm | |
Diamonds represent "If…Then" decision points for logic tests and comparisons. Two or three flow lines exit the decision point to reflect alternative actions based upon an evaluation of the condition(s) stated around the decision point. | |
Rectangles or process boxes show when computation or manipulation of the data are required, such as a calculation or summarization. | |
Circle or "On-page: connectors, labeled with a letter, show a link to sections of the algorithm which are continued on the same page. | |
Five-sided or "Off-page" connectors, labeled with a letter, show a link to sections of the algorithm which are continued on different pages. Note: Both circular, On-page, five-sided, and Off-page Connectors containing the letters B, D, E, U, X, or Y lead to measure Outcome Boxes. | |
Outcome Boxes represent the result of data passed through the algorithm. Connectors extending from outcome boxes lead to the end of the algorithm, or to risk adjustment procedures, where applicable. This symbol is also used to identify the strata within a stratified measure. | |
Symbol to represent comments that should be taken into account when programming flowchart. | |
This symbol is placed along side the Process box to which they are applicable. Comments are used to expand upon information contained within the process box, such as how to properly calculate age. Comments are never the sole location where processing logic is provided. | |
Start/Return denotes the beginning and ending of a sub-routine. Algorithms that use this symbol are called from another algorithm and the data processing flow returns to the calling algorithm when the Return' is encountered. See the Initial Patient Population Algorithms and Transmission Data Processing Flows for an example of the usage of this symbol. |