Future Directions for the National Healthcare Quality and Disparities Reports
E. HHS Interagency Workgroup for the NHQR and NHDR
To select the core set of measures used in the NHQR and NHDR, AHRQ staff and the HHS Interagency Workgroup for the NHQR/NHDR applied three basic criteria recommended by the IOM in 2001—importance, scientific soundness, and feasibility (go to discussion in Box 4-1 in Chapter 4)—to each individual measure, mapped potential measures to the elements of the earlier quality framework (effectiveness, safety, timeliness, and patient-centeredness), and selected clinically important conditions within effectiveness measures.
In an explanation of its selection process for identifying gap areas and priority areas, AHRQ staff provided the Future Directions committee with a side-by-side comparison of the specific factors considered relative to the criterion of importance in the development of the 2005 NHQR and NHDR (Table E-1). The factors included: leading causes of death, disability or activity limitation, or principal hospital diagnoses; costly conditions in general and for hospitalizations specifically; areas with Black-White racial disparities in life years lost, educational disparities in life years lost, and other significant racial and ethnic disparities. The HHS Interagency Workgroup for the NHQR/NHDR determined by looking across these lists that the data supported continued inclusion of the same clinical conditions originally chosen from Healthy People 2010.
Table E-1
| NVSS, 2005 | SIPP, 2001 | NHIS, 1996 | MEPS, 2005 | HCUP, 2005 |
|---|---|---|---|---|
| Leading causes of death | Main causes of disability | Causes of activity limitation | Most costly conditions | Hospital principal diagnoses |
|
|
|
|
|
Table E-1 (continued)
| IOM, 2003 | HHS, 2004 | NHIS, 2002 | NHIS 2002 | NHIS 2002 | NHQR, 2005 NHDR, 2005 |
|---|---|---|---|---|---|
| Priority areas for qualityimprovement | Major threats to the health and well-being of Americans | Black-White disparity in life years lost | Educational disparity in life years lost | Serious racial and ethnic disparities | Interagency Workgroup Consensus |
|
Cancer screening that is evidence based— focus on colorectal and cervical cancer Children with special health care needs Diabetes— focus on appropriate management of early disease End of life with advanced organ system failure— focus on congestive heart failure and chronic obstructive pulmonary disease Frailty associated with old age— preventing falls and pressure ulcers, maximizing function, and developing advanced care plans Hypertension— focus on appropriate management of early disease Immunization— children and adults Ischemic heart disease— prevention, reduction of recurring events, and optimization of functional capacity Major depression— screening and treatment Medication management— preventing medication errors and overuse of antibiotics Nosocomial infections— prevention and surveillance Pain control in advanced cancer Pregnancy and childbirth— appropriate prenatal and intrapartum care Severe and persistent mental illness— focus on treatment in the public sector Stroke— early intervention and rehabilitation Tobacco dependence treatment in adults Obesity (emerging area) |
Reduce behavioral and other factors that contribute to the development of chronic diseases Reduce the incidence of sexually transmitted diseases and unintended pregnancies Increase immunization rates among adults and children Reduce substance abuse Reduce tobacco use, especially among youth Reduce the incidence and consequences of injuries and violence |
|
|
Infant mortality Breast and cervical cancer Diabetes HIV infections/AIDS Child and adult immunizations |
Cancer Diabetes End-stage renal disease Heart disease HIV and AIDS Maternal and child health Respiratory diseases Nursing home and home health care Patient safety Timeliness Patient-centeredness |
Note: This table was provided to IOM by AHRQ. The information contained in this table may not correspond with all of the information included in the source documents. The IOM does not take responsibility for any inconsistencies.
References
AHRQ (Agency for Healthcare Research and Quality). 2005a. National Healthcare Disparities Report, 2005. Rockville, MD: Agency for Healthcare Research and Quality.
—. 2005b. National Healthcare Quality Report, 2005. Rockville, MD: Agency for Healthcare Research and Quality.
—. 2005c. Expenses for selected conditions by type of service: United States, 2005. Rockville, MD: Agency for Healthcare Research and Quality.
CDC (Centers for Disease Control and Prevention). 2001. Prevalence of disabilities and associated health conditions among adults: United States, 1999. Morbidity and Mortality Weekly Report 50(7):120-125.
HCUP (Healthcare Cost and Utilization Project). 2005. Hospitalizations in the United States, 2002. Rockville, MD: Agency for Healthcare Research and Quality.
HHS (U.S. Department of Health and Human Services). 2004. HHS strategic plan FY 2004-2009: Goals. http://aspe.hhs.gov/hhsplan/2004/goals.shtml (accessed March 17, 2010).
IOM (Institute of Medicine). 2003. Priority areas for national action: Transforming health care quality. Washington, DC: The National Academies Press.
Krause, L.E., S. Stoddard, and D. Gilmartin. Chartbook on disability in the United States, 1996. Washington, DC: U.S. National Institute on Disability and Rehabilitation Research.
NVSS (National Vital Statistics System). 2005. Deaths: Leading causes for 2002. Hyattsville, MD: National Center for Health Statistics.
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