Appendix A. Previous IOM Recommendations for the National Healthcare Reports
Subsequent to passage of the Healthcare Research and Quality Act of 19991, AHRQ contracted with the IOM to develop a vision for the NHQR and NHDR. That request led to the publication of two sets of IOM recommendations in the IOM consensus documents: Envisioning the National Healthcare Quality Report (IOM, 2001) and Guidance for the National Healthcare Disparities Report (IOM, 2002). The recommendations offered by the IOM committees follow.
Recommendations for the National Healthcare Quality Report
(IOM, Envisioning the National Healthcare Quality Report, 2001)
- The conceptual framework for the National Health Care Quality Report should address two dimensions:
components of health care quality and consumer perspectives on health care needs. Components of health
care quality—the first dimension—include safety, effectiveness, patient-centeredness, and timeliness.
Consumer perspectives on health care needs—the second dimension—reflect changing consumer needs
for care over the life cycle associated with staying healthy, getting better, living with illness or disability,
and coping with the end of life. Quality can be examined along both dimensions for health care in general
or for specific conditions. The conceptual framework should also provide for the analysis of equity as an
issue that cuts across both dimensions and is reflected in differences in the quality of care received by
different groups of the population.
- The Agency for Healthcare Research and Quality should apply a uniform set of criteria describing desirable
attributes to assess potential individual measures and measure sets for the content areas defined by the
framework. For individual measures, the committee proposes 10 criteria grouped into the three following
sets: (1) the overall importance of the aspects of quality being measured, (2) the scientific soundness
of the measures, and (3) the feasibility of the measures. For the measure set as a whole, the committee
proposes three additional criteria: balance, comprehensiveness, and robustness.
- The Agency for Healthcare Research and Quality should have an ongoing independent committee or
advisory body to help assess and guide improvements over time in the National Health Care Quality Report.
- The Agency for Healthcare Research and Quality should set the long-term goal of using a comprehensive
approach to the assessment and measurement of quality of care as a basis for the National Health Care
Quality Data Set.
- When possible and appropriate, and to enhance robustness, facilitate detection of trends, and simplify presentation
of the measures in the National Health Care Quality Report, the Agency for Healthcare Research
and Quality (AHRQ) should consider combining related individual measures into summary measures of
specific aspects of quality. AHRQ should also make available to the public information on the individual
measures included in any summary measure, as well as the procedures used to construct them.
- The National Health Care Quality Data Set should reflect a balance of outcome-validated process measures
and condition- or procedure-specific outcome measures. Given the weak links between most structures
and outcomes of care and the interests of consumers and providers in processes or practice related
aspects as well as outcome measures, structural measures should be avoided.
- Potential data sources for the National Health Care Quality Data Set should be assessed according to the
following criteria: credibility and validity of the data, national scope and potential to provide state-level
detail, availability and consistency of the data over time and across sources, timeliness of the data, ability
to support population subgroup and condition-specific analyses, and public accessibility of the data. In
addition, in order to support the framework, the ensemble of data sources defined for the National Health
Care Quality Data Set should be comprehensive.
- The Agency for Healthcare Research and Quality will have to draw on a mosaic of public and private
data sources for the National Health Care Quality Data Set. Existent data sources will have to be complemented
by the development of new ones in order to address all of the aspects included in the proposed
framework and resulting measure set. Over the coming decade, the evolution of a comprehensive health
information infrastructure, including standardized, electronic clinical data systems, will greatly facilitate
the definition of an integrated and comprehensive dataset for the Quality Report.
- The data for the National Health Care Quality Report should be nationally representative and, in the long
term, reportable at the state level.
- The National Health Care Quality Report should be produced in several versions tailored to key audiences—policy makers, consumers, purchasers, providers, and researchers. It should feature a limited number of
key findings and the minimum number of measures needed to support these findings.
Source: IOM, 2001.
Recommendations for the National Healthcare Disparities Report
(IOM, Guidance for the National Health Care Disparities Report, 2002)
- The National Healthcare Disparities Report should present analyses of racial and ethnic disparities in
health care in ways that take into account the effects of socioeconomic status.
- AHRQ should pursue a research initiative to more accurately and meaningfully measure socioeconomic status as it relates to health care access, service utilization, and quality.
- Access is a central aspect of health care quality. As such, the National Healthcare Disparities Report
should give it prominent attention.
- The National Healthcare Disparities Report should include measures of high utilization of certain health
care services that indicate poor health care quality. It should also include measures of low utilization of certain health care services, which are more commonly used to indicate poor health care quality.
- The National Healthcare Disparities Report should present data on disparities at the state level. It should
also present data on disparities along a rural-urban continuum.
- In the future, if AHRQ continues to rely on subnational data sources for the National Healthcare Disparities
Report, it should work with public and private organizations that sponsor key subnational data sources to identify core elements in these surveys that can be standardized.
- AHRQ should receive adequate resources to develop datasets and measures needed for the National Healthcare Disparities Report.
Source: IOM, 2002.
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IOM (Institute of Medicine). 2001. Envisioning the National Healthcare Quality Report. Washington, DC: National Academy Press.
—. 2002. Guidance for the National Healthcare Disparities Report. Washington, DC: The National Academies Press.
1 Healthcare Research and Quality Act of 1999, Public Law 106-129 §902(g) and §913(b)(2), 106th Cong., 1st sess. (November 19, 1999).
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