Version 2.

Appendix I:
Measure Sampling

Specification Manual for the Joint Commission International Library of Measures

Version 2.0, effective for January 2013 discharges (1st Quarter 2013)
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Appendix I: Measure Sampling

Introduction
Sampling is a process of selecting a representative part of the population of interest in
order to estimate the organizations performance, without collecting data for its entire
population. Using a statistically valid sample, an organization can measure its
performance in an effective and efficient manner.

Sampling is a particularly useful technique for performance measures that require

primary data collection from a source such as the medical record. Sampling should not
be used unless the organization has a large enough number of cases in the measures
initial eligible population because a fairly large number of sample cases are needed to
accurately reflect the organizations performance. Organizations with large patient
volumes may perform data collection on a sample of the total population, but sampling
is not required.

To obtain statistically valid sample data, the sample size should be carefully determined
and the sample cases should be randomly selected such that individual cases in the
population have an equal chance of being selected. Only when the sample data truly
represent the whole population can the sample-based performance measure data be
meaningful and useful. Guidelines for effective sampling procedures follow.

Sampling may be used for all measures in the Library of Measures except for I-HBIPS-
2, I-HBIPS-3, I-NCS-2, I-NSC-4 and I-NSC-5. These measures cannot be sampled
because they are event-based measures.

Sampling Availability
If an organization decides to sample a measures or measure sets initial eligible
population, sampling should be applied to all monthly discharge medical records
identified as part of the inpatient initial eligible population. Initial eligible population
criteria are described in each measure set chapter of the specification manual.

The initial eligible population should be identified by using available databases or other
information repositories that contain monthly patient discharge information, International
Classification of Diseases (ICD) diagnosis/procedure codes or patient diagnoses or
procedures, and other necessary administrative data (e.g., patient age).

Sampling should be undertaken on a monthly basis.

Specification Manual for the Joint Commission International Library of Measures

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Appendix I: Measure Sampling

Sample Size Requirements

Hospitals selecting sample cases for Library Measures should ensure that its measures
or measure sets initial patient population(s) and sample size(s) meet the following
conditions:

The number of discharged cases to be sampled on a monthly basis is

determined in accordance with the following sampling table:

Measure Sampling Table

Total Monthly Initial Patient Population Required Monthly
Size (N) for the Selected Measure Sample Size (n)
>= 59 58
<= 58 No sampling; 100% population required

If desired, a hospital may select a larger monthly sample size.

Sample Size Examples:

A hospital has 57 discharges (N) in a month for a given measure initial patient
population. All 57 cases (100%) should be reviewed. Sampling is not
appropriate in this example.
A hospital has 128 discharges (N) in a month for a given measure initial patient
population. The sample size for this month would be 58 cases (n).
A hospital has 512 discharges (N) in a month for a given measure initial patient
population. The sample size for this month would be 58 cases (n).
A hospital has 905 discharges (N) in a month for a given measure initial patient
population. The sample size for this month would be 58 cases (n) (the maximum
required number of cases for the monthly sample size).

According to the sampling table, it is possible in the same measure to have No

sampling (<58 initial patient population discharge cases) in one month and be able to
sample with the next month of cases, if there are a sufficient number of initial patient
population discharge cases to support the sampling methodology as described.

Systematic Random Sampling Approach

Systematic random sampling requires every kth record from a population size of N in
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Appendix I: Measure Sampling

such a way that a sample size of n is obtained, where k < N/n. The first sample record
(i.e., the starting point) must be randomly selected before taking every kth record. This
is a two-step process as follows:

1. Select the starting point; and

2. Then select every kth record thereafter until the selection of the sample size is
complete.

Random Selection Example: How to apply random sampling

For a measure or measure set with an initial patient population size of 360 discharges
per month (N), the sample size would be 58 (n) according to the table provided in this
section. To select a random sample of 58 cases you would implement the following
process:

1. Determine the initial patient population size N (i.e., the total number of
discharges associated with the selected measure) for the month.
2. Determine the sample size n using the above table.
3. Divide the population size N by the suggested sample size n and the quotient
is k (i.e., the resulting integer is the sampling interval k).
Example: How to get sample interval number
a. The sampling interval k = 360/58 = 6 sampling interval (k)
b. Thus, every 6th (k) patient record will be selected from the measure
population until 58 cases have been selected.

4. To ensure that each patient has an equal chance of being selected,

the starting point must be randomly determined before selecting
every 6th record.
Example: How to determine starting point
a. Therefore, a simple approach to determine where to start would be to
write the numbers 1,2,3,4,5 on separate pieces of paper and
b. Then place the numbers in a container and pull one piece of paper
identifying a number to start counting the k sampling interval
i. For example, if you draw number 3, start with the 3rd case on
your list and select every 6th case after that until you reach 58
cases.

Specification Manual for the Joint Commission International Library of Measures

Version 2.0, effective for January 2013 discharges (1st Quarter 2013)
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