For structural measures, the structure should be closely linked to a meaningful process of care that in turn is linked to a meaningful patient outcome. b. For process measures, the scientific basis for the measure should be well established, and the process should be closely linked to a meaningful patient outcome. c. For outcome measures, the outcome should be clinically meaningful. If appropriate, performance measures based on outcomes should adjust for relevant clinical characteristics through the use of appropriate methodology and high-quality data sources. 2. Measure Selection Measure definition a. The patient group to whom the measure applies (denominator) and the patient group for whom conformance is achieved (numerator) are clearly defined and clinically meaningful. Measure exceptions and exclusions b. Exceptions and exclusions are supported by evidence. Reliability c. The measure is reproducible across organizations and delivery settings. Face validity d. The measure appears to assess what it is intended to. Content validity e. The measure captures most meaningful aspects of care. Construct validity f. The measure correlates well with other measures of the same aspect of care. 3. Measure Feasibility Reasonable effort and cost a. The data required for the measure can be obtained with reasonable effort and cost. Reasonable time period b. The data required for the measure can be obtained within the period allowed for data collection. Actionable a. Those held accountable can affect the care process or outcome. Unintended consequences avoided b. The likelihood of negative unintended consequences with the measure is low. Reproduced with permission from Thomas et al.25 Copyright 2018, American Heart Association, Inc., and American College of Cardiology Foundation. ACC indicates American College of Cardiology; and AHA, American Heart Association. 11 Table 8. New Performance, Quality, and Structural Measures for the Diagnosis and Management of HBP in the Outpatient Care Setting* Measure No. 