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Module 4: Measurement Matters—Setting Up an Efficient and Effective Strategy for Assessing Progress and Detecting Success

Learning objectives


Action steps and tools

Learning objectives

  • Describe measurement for improvement and why it is critical to PCMH transformation
  • Help leaders, clinicians, managers, staff, and patients develop a measurement and reporting strategy to support PCMH transformation


Measurement is an essential part of improvement and PCMH transformation. It crystallizes goals and serves as a mechanism for communicating goals and monitoring progress. But why should practices put resources into this? And how do they set up an approach that balances the needs of leadership, recognition reporting, and day-to-day work?

Through measurement reporting, a practice can:

  • Demonstrate to the board, leaders, staff, patients, and families that high-quality, evidence-based care is being provided in a timely manner
  • Identify opportunities for further improvement
  • Become recognized as a PCMH
  • Become eligible for additional funding and resources through Meaningful Use, pay-for performance programs, demonstration projects, grants, etc.

This module equips the practice facilitator with practical examples and tested tools to support practices as they develop, implement, and sustain measurement approaches.

Action steps and tools

Action step Tool

Why measurement for improvement is critical to PCMH transformation

The three faces of performance measurement: improvement, accountability, and research
Article presents case study of learning how to distinguish between measurement for improvement and measurement for accountability.

Stage 2 Meaningful Use and NCQA PCMH 2014 Standards Crosswalk
Explains the overlap and alignment between Stage 2 Meaningful Use and the NCQA recognitions 2014 standards.

Build an improvement-focused measurement strategy

SNMHI Engaged Leadership Guide
Helpful for engaging leaders in measurement, esp. the section on Leadership's Role with Quality Improvement Data.

Measurement principles and checklist for getting started
A list of measurement principles from the Institute for Healthcare Improvement for those who are new to measurement as well as a list of activities to consider for getting started.

Measurement menu
Use this in a coaching session to help the team select measures that fit their measurement strategy.

Putting Measurement Into Practice With a Clinical Instrument Panel
Courtesy of the American Academy of Family Physicians (AAFP), this tool makes the case for why a balanced set is needed. Includes a sample instrument panel.

SNMHI Threshold Reference Table
This tool provides links to various reports with national benchmarks for common clinical quality measures. The SNMHI used this to assist sites in setting goals based on the national 90th percentile performance.

Registries Made Simple
This article from AAFP explains how to build a registry in 5 easy steps.

Make measurement part of daily work through reporting

Sample presentations

Run charts and other visual displays: tools and examples

Provide practices with tools they can use

Safety Net Medical Home Initiative
Contains a wealth of corresponding tools and information for practices.