These limitations left the writing committee less enthusiastic about sup- porting a measure at the present time, but this should be a priority area for future investigation. 4.2. Outcome Measures If the focus of process measures re ects the journey, outcome measures shed light on the destinationdthe end, rather than the means. Outcome measures offer the potential advantage of providing readouts on entire populations, rather than smaller population subsets, and they focus on the end results of care that are most important to clinicians and patients. The challenges with outcome measures are primarily in the risk-adjustment modeling methods, which, though never perfect, can substantially enhance the ability to compare outcomes across different delivery teams, settings, locations, and systems (20). Krumholz et al. (20) have described 7 preferred attributes of models used for outcomes that are publicly reported (Table 5), which this the writing com- mittee strongly believes should remain at the core of any performance measure that includes outcomes. Table 5. Preferred Attributes of Models Used for Publicly Reported Outcomes 1. Clear and explicit definition of an appropriate patient sample 2. Clinical coherence of model variables 3. Sufficient high-quality and timely data 4. Designation of an appropriate reference time before which covariates are derived and after which outcomes are derived 5. Use of an appropriate outcome and a standardized period of outcome assessment 6. Application of an analytical approach that takes into account the multilevel organization of data 7. Disclosure of the methods used to compare outcomes, including disclosure of performance or risk-adjustment methodology in derivation and validation samples Reprinted with permission from Krumholz et al. (20). JACC Vol. 63, No. 7, 2014 Nallamothu et al. February 25, 2014:722 45 ACC/AHA/SCAI/AMA-PCPI/NCQA 4.2.1. 