Measures and Topics
Measures are entities used to quantify healthcare processes, outcomes, and patient survey results for hospitals, nursing homes, physicians, and clinical groups. Measures are mostly represented as rates in percentage and used in the reports for comparing various providers.
Similar measures are grouped into Topics, which are further grouped into Topic Categories. A measure may be assigned to multiple topics.
Measures, their Topics, and Topic Categories are directly related to the Targets that define them. They are imported into the MONAHRQ database along with a custom Target’s other installation logic. They may be associated with one or more websites, and are consumed by Report Generators.
Associations between measures and topics may also be changed by MONAHRQ Host Users from the "Measures" library.
There are more than 100 topics shipped with MONAHRQ. Most of these are maintained in a CSV file located in
Monahrq.Infrastructure\Resource\BaseData\MeasureTopics.csv and are loaded by the
Monahrq.Infrastructure.BaseDataLoader.LoadersTopicsStrategy class an implementation of
IBasedataImporter. See
Loading and Updating Base Data for more
information on the import and update process for topics included in this CSV file.
Most built-in measures are installed as part of the installation process for built-in Wings, which is described in Installing into the MONAHRQ Database.
The specific steps for defining custom measures and topics varies depending on the method chosen to maintain those measures and topics. At a high level, the procedure is roughly the same:
- Insert any missing TopicCategories
- Insert any missing Topics
- Insert or update Measures and associate them with your Topics and Target type
Installation of Measures, their Topics and Topic Categories into the MONAHRQ database is handled by the Target’s
Module Definition. Although not required, this section assumes
that your Module Definition inherits from TargetedModuleWithMeasuresAndTopics<T>.
This method is intended to create or update database rows related to measure Topics and their Topic Categories.
It is executed before ImportMeasures() as Measures must be associated with a Topic. Implementers of this
method should query the database for required TopicCategory and Topic records, inserting any missing records
or updating existing records as needed.
ℹ️IMeasureService provides simple methods for importing topics and measures from the
filesystem. For information about the expected file format, refer to
Monahrq.Infrastructure.Entities.Domain.Measures.MeasureService.
This method is intended to create or update database rows related to individual Measures, if the required Topics
have already been created. It is executed after ImportMeasureTopics(). Implementers of this method should
query the database for required Measure records, inserting any missing records or updating existing records as
needed.
var measure = session.Query<Measure>().FirstOrDefault(m => m.Name == "Sample Measure");
var target = session.Query<Target>().FirstOrDefault(
t => t.Name == this.TargetAttribute.Name);
if (measure == null)
{
measure = Measure.CreateMeasure(typeof(HospitalMeasure), target, "SMPL-1");
measure.MeasureTitle.Plain = "My Sample Hospital Measure";
measure.MeasureTitle.Clinical = "Sample Hospital Measure SMPL-1";
measure.MeasureTitle.Policy = "Sample Hospital Measure SMPL-1";
measure.AddTopic(topic);
topic.Measures.Add(measure);
session.Save(measure);
}If you choose to define your measures and/or measure topics in the filesystem, these properties may be used to
determine if measures and/or measure topics have changed and need to be re-installed. This determination is made
by comparing the last write timestamp of the file to the LastWingUpdate column in the Wing table; for more
information, refer to the TargetedModuleWithMeasuresAndTopics<T>.RefreshDb() source code.
To use this functionality, return the path of your measure and/or measure topic files. To disable this functionality, return a null value from these properties.
Several different types of Measures are included with MONAHRQ
- CountyMeasure
- DynamicMeasure
- HospitalMeasure
- Measure
- NursingHomeMeasure
- PhysicianMeasure
- RegionMeasure
While different measure types receive slightly different treatment in the MONAHRQ Host User interface (Refer to
Monahrq.Measures.ViewModels.MeasureDetailsViewModel,
Monahrq.Website.ViewModels.WebsiteEditMeasuresViewModel, and
Monahrq.Website.ViewModels.WebsiteMeasuresViewModel) , there is no functional difference in the different
types. For consistency, choose the most appropriate measure type for your purpose; if no type is directly
applicable, use the Measure base class.
The chosen measure type implementation is passed as the first parameter to the Measure.CreateMeasure(Type, Target, String) method. The measure type is stored in the Measures.ClassType database column.
Each measure is given a unique, human readable, string identifier. In the example above, the ID is "SMPL-1"; this suggests that the measure belongs to the SMPL (or "Sample") module and is the first measure in that module. Other examples of measure IDs are "IQI 01" (inpatient quality indicators #1), "IP-10" (inpatient county median cost). There are no conventions or requirements for this code if it is supplied and unique.
The terms "measure name" and "measure ID" are sometimes used interchangeably.
The recommended method for managing topics and measures is to store them in XML or CSV files, which are parsed
during the installation process; these files may be stored in the filesystem or as embedded resources. Refer
Monahrq.Wing.Ahrq for a sample using CSV files, and Monahrq.Wing.HospitalSpendingSample for a sample
using XML files.
ℹ️The schema of these files is defined by the module(s) that read them. Although there is some consistency (i.e.: CSV and XML files from one module are very similar to CSV and XML files from another module), there is no standard.
Measures and topics are exposed in the MONAHRQ Host User interface in the Measures library, and in the "Modify Measures" tab of the Websites library. In either location, measure names and descriptions may be edited, along with their relationship to topics.