The adjusted quartile ranking assesses health centers’ performance in clinical quality measures (CQMs) compared to other health centers with similar patient demographics and organizational characteristics. The CQM data come from the Uniform Data System (UDS), a standardized reporting system used to assess the impact and performance of the Health Center Program and promote data-driven quality improvement.
Adjusted quartile rankings differ from rankings based on actual (unadjusted) performance on specific measures and account for the following differences in health center characteristics:
- Percent of patients who are uninsured
- Percent of racial and/or ethnic minority patients
- Percent of patients experiencing homelessness
- Percent of patients who are migrant and seasonal farmworkers
- Electronic Heath Record (EHR) status
Clinical performance for each measure is ranked from quartile 1 (highest 25% of reporting health centers) to quartile 4 (lowest 25% of reporting health centers). Also, see the Health Center Adjusted Quartile Ranking Frequently Asked Questions.
HRSA calculates these adjusted measures each year using the most currently available UDS data, so the thresholds between adjusted quartiles may not be consistent year-to-year, and HRSA is unable to calculate these values in advance.
Note: Clinical quality measures (CQMs) with fewer than 30 patients that meet the measure criteria in the denominator are excluded.
Purpose
Adjusted quartile rankings provide health centers with information on their relative performance compared to other health centers for each of the following CQMs reported in the UDS, after adjusting for certain health center characteristics (percent of uninsured, minority, homeless, and migrant and seasonal farmworker patients and EHR status):
- Early Entry into Prenatal Care
- Childhood Immunization Status
- Cervical Cancer Screening
- Breast Cancer Screening
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
- Body Mass Index (BMI) Screening and Follow-Up Plan (18 and Older)
- Tobacco Use: Screening and Cessation Intervention
- Statin Therapy for Prevention and Treatment of Cardiovascular Disease
- Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet
- Colorectal Cancer Screening
- HIV Linkage to Care
- HIV Screening
- Screening for Depression and Follow-Up Plan
- Depression Remission at Twelve Months
- Dental Sealants for Children 6-9 Years
- Low Birth Weight
- Controlling High Blood Pressure
- Diabetes: Hemoglobin A1c (HbA1c) Poor Control (˃9%)
Note that EHR status is not relevant for the two measures on which all patients are reported: early entry into prenatal care and low birth weight. Adjusted rankings for these measures are based percent of patients who are uninsured, minority, and from special populations (homeless and migrant and seasonal farmworkers).
A health center should expect to see a higher ranking if performance is above what is predicted for a health center with similar characteristics based on these adjustments. Conversely, a health center should expect to see a lower ranking if performance is below what is predicted for a health center with similar characteristics.
Considerations
Adjusted quartile rankings do not replace the actual performance rates for CQMs reported in the UDS. HRSA recommends that health centers use actual (unadjusted) performance rates for their own quality improvement efforts. HRSA also uses actual (unadjusted) performance rates to assess health center performance on CQMs over time. CQM values for all HRSA-funded health centers are available in the downloadable full datasets on the HRSA Electronic Reading Room page.
Reporting health centers will receive their own adjusted rankings. If a ranking is identified as an outlier, the affected health center will not receive the ranking for that measure. This outlier exclusion means that the adjusted quartile ranking is considered to be a statistical anomaly and has no negative implications because outliers and non-rankings do not allow for an adequate evaluation of health center performance. For example, outliers or non-rankings might occur due to a small sample size of 70 or fewer patients.
The adjusted quartile ranking process is reviewed annually.