When Clinigence designs a program, we try to write the measures so that whenever possible, a higher score means better performance. When we are given the measure criteria from an authority, like PQRI, we must follow their description and create “Lower Is Better” measures.
Lower Is Better Measures
An example of a 'lower is better' measure is based on NQF 0059: Diabetes: Poor Control HgA1c > 9%. You want to have fewer patients in the numerator; those with an out of range HgA1c result. On the Measure Details screen, the display shows the actual numbers, as the measure was defined by the authority. In the example below, there are 0 patients with HgA1c > 9% out of 3 patients qualifying for the denominator.
This measure is aggregated differently from "higher is better" measures when rolled up to the guideline and program levels. When this measure is aggregated for the provider or practice, Clinigence “flips” the score so that all roll-up and aggregate scores include the Complement, rather than the Numerator. We do this so that the aggregate scores are not improperly lowered by a “lower is better” individual measure. For example, if a provider’s score on this measure is 10% (10/100 diabetic patients had a Hg A1c > 9%), when that score is rolled up we use 90% (the Complement) as the score to aggregate.