How Quality Scores Are Calculated

Every quality number in Theator — a case's best-practice result, a SPEQ status, and a Quality Initiative's Adoption Rate — is built from one simple decision made on each case: was the best practice followed, yes or no. This article explains how that per-case decision is made, why a single case can show a fraction like 1 of 2, and how those results roll up into the percentage you see on an initiative.

How each practice is scored on a case

For every eligible case, Theator scores each best practice as a single yes/no result:

• Met -- the best practice was followed in this case.
• Not Met -- the best practice was not followed in this case.
• Not Applicable -- the practice did not apply to this case, so the case is not counted at all.

Scoring is binary at the case level: a case either followed the practice or it did not. There is no partial credit for a case. This is why, in a Quality Initiative, it is cases that are counted — not individual checks within a case.

When a practice has more than one check (sub-evaluations)

Some best practices verify more than one thing in the same case. For example, a practice for identifying the ureters during a hysterectomy checks that both the left and the right ureter were identified. Each of those checks is a sub-evaluation.

When you open the case, you may see how many sub-evaluations passed, shown as a fraction such as 1 of 2 — meaning one of the two required checks was met and the other was not.

The sub-evaluation fraction is a detail on the case, not the case's score. For the case to count as followed, all of the practice's required sub-evaluations must pass. So even when a practice contains several sub-evaluations, the case-level result is still a single Met or Not Met.

How the Adoption Rate is calculated

An initiative's Adoption Rate is a percentage of cases:

Adoption Rate = cases where the practice was followed ÷ eligible cases

• Eligible cases are the cases the practice applied to (the denominator). Cases scored Not Applicable are not eligible and are never counted.
• Cases where the practice was followed are the eligible cases scored Met (the numerator).

Because the count is of cases, the numerator and denominator are always whole numbers of cases — for example, 19 of 22 cases. The sub-evaluation fractions on individual cases do not appear in this ratio; each case contributes only its single Met or Not Met result.

Why the Adoption Rate changes over time

A Quality Initiative measures the cases that fall inside its time window, and the Adoption Rate is recalculated as new cases are recorded and processed. As more eligible cases arrive, both the numerator and the denominator grow.

That is why a rate can move from, say, 15 of 16 cases to 19 of 22 cases without any earlier case changing its result — three more eligible cases were measured, and one of them was Not Met. Early in an initiative the rate is based on only a handful of cases, so expect it to shift as case volume grows and to settle as the window fills in.

What's Next?

• What is an SPEQ? — Understand the Met / Not Met / Not Applicable statuses behind every score
• Manage Quality Initiatives — Track adoption rates and trends for a best practice over time
• Exploring Best Practices and the Catalog — Browse the best practices library and their adoption rates