Quality Measures

Overview

Code on GitHub

The Quality Measures data mart combines CMS-oriented quality measure logic and hospital readmission logic in one package. The measure outputs and readmission outputs remain in separate model folders, but they are documented together because both workflows support health plan and population quality reporting.

CMS publishes Medicare Part C and Part D Star Ratings technical notes and performance data on the Part C and D Performance Data page. CMS also publishes hospital outcome methodology, including hospital-wide readmission resources, on its Measure Methodology page.

Install this standalone package alongside Core using the data mart installation guide.

Methodology

The quality measure workflow evaluates denominator, numerator, exclusion, and performance logic for each supported measure. It produces patient-level measure rows, a patient-level pivot, and summary counts with performance rates.

The readmissions workflow identifies index admissions, applies exclusion logic, detects planned admissions, and flags all-cause and unplanned 30-day readmissions. The logic is designed around CMS-style readmission concepts, including index admissions, 30-day follow-up windows, transfer handling, discharge status, run-out checks, and planned readmission exclusions.

The package implements the measures below using its bundled definitions and value sets. The identifiers below are the values used in the package outputs, not a promise of inclusion in a particular CMS Star rating year. NCQA-authored HEDIS measure implementations are excluded from this open-source package. Review the applicable specification and reporting population before using these outputs for external reporting.

Measure Name	Output identifier	Specification	Status
Documentation of Current Medications in the Medical Record	CQM130	Specification	Released
Hospital-Wide All-Cause Readmission	Separate readmission_summary workflow	Methodology	Released
Medication Adherence for Cholesterol (Statins)	ADH-Statins	CMS Star Ratings technical notes	Released
Medication Adherence for Diabetes Medications	ADH-Diabetes	CMS Star Ratings technical notes	Released
Medication Adherence for Hypertension (RAS antagonists)	ADH-RAS	CMS Star Ratings technical notes	Released
Pain Assessment and Follow-Up	NQF0420	Specification	Released
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	CQM438	QPP measure search	Released
Statin Use in Persons with Diabetes	SUPD	CMS Star Ratings technical notes	Released

Configuration

The tested 1.0 package graph uses claims data. Do not assume that setting claims_enabled: false and clinical_enabled: true enables every Quality Measures model; check the selected model's domain requirements.

The data mart supports a measurement-period end date.

• quality_measures_period_end defaults to the current year-end. The package does not implement snapshots_enabled. To retain multiple measurement periods, run the desired period explicitly and preserve its results in a separate downstream history table or output schema.

vars:
    quality_measures_period_end: "2026-12-31"

Outputs

Model	Description
quality_measures.summary_counts	Counts and rates by data source, measure, measure version, and performance period.
quality_measures.summary_long	One row per person, data source, measure, measure version, and performance period with denominator, numerator, exclusion, and performance flags.
quality_measures.summary_wide	Patient-level pivot of measure output for reporting and downstream analytics.
quality_measures.readmission_summary	Encounter-level index admission and readmission flags.
quality_measures.encounter_augmented	Encounter-level detail augmented with readmission-relevant data quality and cohort context.

Measure Concepts

Concept	Description
Measure ID	Identifier assigned by the measure steward or reporting program. A measure can have several identifiers across CMS Star Ratings, MIPS, NQF, and eCQM contexts.
Denominator	Population eligible for a measure.
Numerator	Subset of the denominator that received the service, met the clinical target, or had the measured outcome.
Exclusion	Reason a person or encounter is removed from the measure population.
Performance period	Time window used to evaluate the measure.
Value sets	Standard code lists used to define clinical concepts in the measure logic.

Example SQL

Quality Measure Performance

select
      data_source
    , measure_id
    , measure_name
    , performance_period_end
    , denominator_sum
    , numerator_sum
    , exclusion_sum
    , performance_rate
from quality_measures.summary_counts
order by performance_rate desc;

Exclusion Reason Breakdown

select
      measure_id
    , exclusion_reason
    , count(person_id) as patient_count
from quality_measures.summary_long
where exclusion_flag = 1
group by
      measure_id
    , exclusion_reason
order by
      measure_id
    , exclusion_reason;

Overall 30-Day Unplanned Readmission Rate

select
    100.0 * sum(case when index_admission_flag = 1 and unplanned_readmit_30_flag = 1 then 1 else 0 end)
    / nullif(sum(case when index_admission_flag = 1 then 1 else 0 end), 0) as readmission_rate
from quality_measures.readmission_summary;

30-Day Readmission Rate by Discharge Date

with readmissions as (
    select
          discharge_date
        , sum(case when index_admission_flag = 1 then 1 else 0 end) as index_admissions
        , sum(case when index_admission_flag = 1 and unplanned_readmit_30_flag = 1 then 1 else 0 end) as readmissions
    from quality_measures.readmission_summary
    group by discharge_date
)

select
      discharge_date
    , index_admissions
    , readmissions
    , case
        when index_admissions = 0 then 0
        else 1.0 * readmissions / index_admissions
      end as readmission_rate
from readmissions
order by discharge_date;

Readmission Data Quality Detail

select *
from quality_measures.encounter_augmented
where disqualified_encounter_flag = 1;