HEALTHCARE QUALITY PAGE
Published December 2023
Exclusions and exceptions in quality-of-care measures — Can we standardize calculations to improve the validity of measurement done for quality improvement purposes?
Quality-of-care measure developers often confuse exclusions and exceptions in measures. The consequence is a challenge to the validity of the data related to a measure and how data should be interpreted.
Exclusions define precisely the population a measure applies to. They are not included in the group of patients whose care is being measured. It means the target population to which a measure is being applied has to be specified carefully, considering factors such as age, how a diagnosis or procedure is defined, timing of illness onset, complex cases, comorbidities, or duration of illness, as examples.
Exceptions explain the justification for an aspect of care being measured not being provided for an individual patient who is in the population defined for measurement purposes. Exceptions are clinically acceptable reasons why a patient did not have care indicated by a measure. Examples include a patient declining the care, a contraindication, or patient-specific circumstances,
The distinction matters because exclusions should not be included in calculation of compliance with a measure. Exceptions, however, should be added to the numerator to acknowledge that the clinical decision not to provide the specified care was appropriate.
