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move on to measure specification where technical specifications are developed, data sources are

identified, and protocol documents are drafted. Next, the measures move into testing where they are

evaluated on face validity, feasibility, reliability, and burden inputs. For the measures that advance from

testing, they move on to implementation which includes measure selection, rollout, NQF endorsement,

and CMS Consensus-based entity approval (CMS, Quality Measures: How They are Developed, Used, &

Maintained, 2022). Once implemented, measures undergo an annual update, reevaluation, and review

to inform continued usability.

Figure 1. The Quality Measure Development Process and Lifecycle

Model adapted from CMS (CMS, Quality Measures: How They are Developed, Used, & Maintained, 2022).

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