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Preliminary Measure Set, National Healthcare Quality Report

Congress has given the Agency for Healthcare Research and Quality (AHRQ) a mandate to report annually to the Nation about health care quality. An interagency workgroup developed a preliminary set of quality measures for the report (below), and AHRQ seeks comments on the measures.

Select for Background on the preliminary measures and the Update on the National Healthcare Quality Report.

Effectiveness of Care
Cancer / Chronic kidney disease / Diabetes / Heart disease / HIV/AIDS / Maternal and child health /
Mental health / Respiratory diseases / Long-term care
Safety
Timeliness
Patient Centeredness of Care
Resource Consumption
Overall Measures

Effectiveness of Care

Topic Condition	Measure	National Data Base^a	State Data Base^a	Consensus Process^b
Cancer: Screening for breast cancer	Process: % of women (age 40 and over, 50-69) who report they had a mammogram within the past 2 years	NHIS	BRFSS	NCQA, HP2010, AMA
Cancer: Screening for breast cancer	Outcome: % of breast cancers diagnosed at late stage	SEER
Cancer: Screening for cervical cancer	Process: % of women (18 and over) who report that they had a Pap smear within the past 3 years	NHIS	BRFSS	NCQA, HP2010
Cancer: Screening for cervical cancer	Outcome: % of cervical cancers diagnosed at late stage	SEER
Cancer: Screening for colorectal cancer	Process: % of men and women (50 and older) who report they ever had a flexible sigmoidoscopy/colonoscopy	NHIS	BRFSS	HP2010
	Process: % of men and women (50 and over) who report they had a fecal occult blood test (FOBT) within the past 2 years	NHIS	BRFSS	HP2010
	Outcome: % of colorectal cancers diagnosed at late stage	SEER
Cancer: Cancer treatment	Outcome: Cancer deaths per 100,000 persons per year for all cancers	Vital statistics	Vital statistics	HP2010
	Outcome: Cancer deaths per 100,000 persons per year for most common cancers, prostate cancer	Vital statistics	Vital statistics	HP2010
	Outcome: Cancer deaths per 100,000 persons per year for most common cancers, breast cancer	Vital statistics	Vital statistics	HP2010
	Outcome: Cancer deaths per 100,000 persons per year for most common cancers, lung cancer	Vital statistics	Vital statistics	HP2010
	Outcome: Cancer deaths per 100,000 persons per year for most common cancers, colorectal cancer	Vital statistics	Vital statistics	HP2010
Cancer: Palliative care	Process: % of people who died of cancer who received hospice care	NHHCS
	Process: Average length of stay for cancer patients who received hospice care (reflects delayed referrals)	NHHCS
	Process: % of cancer patients receiving hospice care in the home who were transferred to inpatient care (ability to maintain pt. at home)	NHHCS
Chronic kidney disease: Management of end-stage renal disease (ESRD)	Number of patients on waiting list for kidney transplant and number of transplants	USRDS	USRDS
	Outcome: Average urea reduction ratio	USRDS	USRDS	CMS
	Outcome: Average hematocrit	USRDS	USRDS	CMS
	Outcome: First year patient death rates, by treatment modality	USRDS	USRDS	CMS
Diabetes: Management of diabetes	Process: % of people with diabetes with condition diagnosed	NHANES		HP2010
	Process: % of adults with diabetes who had a hemoglobin A1c measurement at least once in past year	MEPS	BRFSS	AMA/JCAHO/ NCQA, HP2010
	Process: % of patients with diabetes who had a lipid profile in past two years	MEPS		AMA/JCAHO/ NCQA
	Process: % of adults with diabetes who had a retinal eye examination in past year	MEPS	BRFSS	AMA/JCAHO/ NCQA, HP2010
	Process: % of adults with diabetes who had a foot examination in past year	MEPS	BRFSS	AMA/JCAHO/ NCQA, HP2010
	Process: % of adults with diabetes who had an influenza immunization in past year	MEPS	BRFSS	AMA/JCAHO/ NCQA
	Outcome: % of adults with diabetes with HbA1c level under control	NHANES		AMA/JCAHO/ NCQA
	Outcome: % of adults with diabetes with lipid level under control	NHANES		AMA/JCAHO/ NCQA
	Outcome: % of adults with diabetes with blood pressure under control	NHANES		AMA/JCAHO/ NCQA
	Outcome: Hospital admissions for uncontrolled diabetes per 100,000 population	HCUP	HCUP	HP2010, HCUP-QI
	Outcome: Hospital admissions for short term complications of diabetes per 100,000 population	HCUP	HCUP	HCUP-QI
	Outcome: Hospital admissions for long term complications of diabetes per 100,000 population	HCUP	HCUP	HCUP-QI
	Outcome: Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 population	NHDS, HCUP	HCUP	HP2010, HCUP-QI
Heart disease: Screening for high blood pressure	Process: % of people age 21 and over having blood pressure checked within past 2 years	NHIS	BRFSS
Heart disease: Screening for high cholesterol	Process: % of men (age 35-65) and women (age 45-65) receiving cholesterol measurement within past 5 years	NHIS	BRFSS	HP2010
Heart disease: Counseling on risk factors	Process: % of smokers receiving advice to quit smoking	MEPS	BRFSS	NCQA, HP2010, AMA
Heart disease: Treatment of acute myocardial infarction (AMI)	Process: % of AMI patients administered aspirin within 24 hours of admission	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NCQA, NQF(draft)
	Process: % of AMI patients with aspirin prescribed at discharge	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of AMI patients administered beta blocker within 24 hours of admission	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of AMI patients with beta blocker prescribed at discharge	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of AMI patients given smoking cessation counseling while hospitalized	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: Median time from admission to reperfusion for AMI patients with ST segment elevation or left bundle branch block	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Outcome: AMI mortality (within 30 days of admission)	Medicare claims	Medicare claims	~JCAHO, NQF(draft)
Heart disease: Treatment of acute heart failure	Process: % of heart failure patients having evaluation of left ventricular ejection fraction	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Outcome: Mortality after acute heart failure (within 30 days of admission)	Medicare claims	Medicare claims	~JCAHO, NQF(draft)
Heart disease: Management of hypertension	Outcome: % of people with hypertension who have blood pressure under control	NHANES		NCQA, HP2010
Heart disease: Management of congestive heart failure (CHF)	Outcome: Hospital admissions for congestive heart failure (CHF) per 100,000 population	NHDS, HCUP	HCUP	HP2010, HCUP-QI
HIV/AIDS: AIDS prevention	Outcome: New AIDS cases per 100,000 population (age 13 and over)	HIV/AIDS surveillance system	HIV/AIDS surveillance system	HP2010
HIV/AIDS: Management of HIV/AIDS	Process: % of HIV-infected persons receiving highly active antiretroviral therapy (HAART)	Adult Spectrum of Disease Survey		HP2010
HIV/AIDS: Management of HIV/AIDS	Outcome: HIV-infection deaths per 100,000 population	Vital statistics	Vital statistics	HP2010
HIV/AIDS: Palliative care	Process: % of people who died of AIDS who received hospice care	NHHCS
	Process: Average length of stay for AIDS patients who received hospice care (reflects delayed referrals)	NHHCS
	Process: % of AIDS patients receiving hospice care in the home who were transferred to inpatient care (ability to maintain patient at home)	NHHCS
Maternal and child health: Maternity care	Process: % of pregnant women receiving prenatal care in first trimester	Vital Statistics	Vital Statistics	HP2010, LHI
	Outcome: % of liveborn infants with low and very low birthweight (less than 2,500 grams, less than 1,500 grams)	Vital Statistics	Vital Statistics	HP2010
	Outcome: Infant mortality per 1,000 live births, by birth weight	Vital Statistics	Vital Statistics	HP2010, JCAHO
	Outcome: Maternal deaths per 100,000 live births	Vital Statistics	Vital Statistics	HP2010
	[See Safety measures for complications of obstetric care]
Maternal and child health: Childhood immunizations	Process: % of children 19-35 months who received all recommended vaccines	NIS	NIS	NCQA, HP2010, LHI
	Process: % of children 19-35 months who received 4 doses of DPaT vaccine	NIS	NIS	NCQA, HP2010
	Process: % of children 19-35 months who received 3 doses of polio vaccine	NIS	NIS	NCQA, HP2010
	Process: % of children 19-35 months who received 1 dose of MMR vaccine	NIS	NIS	NCQA, HP2010
	Process: % of children 19-35 months who received 3 doses of Hib vaccine	NIS	NIS	NCQA, HP2010
	Process: % of children 19-35 months who received 3 doses of hepatitis B vaccine	NIS	NIS	NCQA, HP2010
	Process: % of children 19-35 months who received 1 dose of varicella vaccine	NIS	NIS	NCQA, HP2010
Maternal and child health: Adolescent immunizations	Process: % of adolescents (age 13-15) reported to have received 3 or more doses of hepatitis B vaccine	NHIS		HP2010
	Process: % of adolescents (age 13-15) reported to have received 2 or more doses of MMR vaccine	NHIS		HP2010
	Process: % of adolescents (age 13-15) reported to have received 1 or more doses of tetanus-diphtheria booster	NHIS		HP2010
	Process: % of adolescents (age 13-15) reported to have received 3 or more doses of varicella vaccine	NHIS		HP2010
Maternal and child health: Childhood dental care	Process: Time since last dental contact (1 year or less, more than 1 year but not more than 3 years, more than 3 years)	NHIS
Maternal and child health: Childhood dental care	Outcome: % of children with untreated dental decay	NHANES		HP2010
Maternal and child health: Treatment of pediatric gastroenteritis	Outcome: Hospital admissions for pediatric gastroenteritis per 100,000 population less than 18 years of age	HCUP	HCUP	HCUP-QI
Mental health: Treatment of depression	Process: % of adults with depression who received treatment	NHSDA	NHSDA	HP2010, LHI
	Process: % of adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase	HEDIS		NCQA
	Process: % of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase	HEDIS		NCQA
	Process: % of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment	HEDIS		NCQA
	Outcome: Deaths due to suicide per 100,000 population	Vital Statistics	Vital Statistics	HP2010
Respiratory diseases: Influenza immunization	Process: % of high risk persons (e.g. COPD) age 18-64 who received an influenza vaccination in the past 12 months	NHIS	BRFSS	HP2010
	Process: % of persons age 65 and over who received an influenza vaccination in the past 12 months	NHIS	BRFSS	NCQA, HP2010, LHI
	Process: % of institutionalized adults (persons in long-term care or nursing homes) who received influenza vaccination in past 12 months	NNHS		HP2010
	Outcome: Hospital admissions for immunization-preventable influenza per 100,000 population	HCUP	HCUP	HP2010
Respiratory diseases: Pneumococcal immunization	Process: % of high risk persons (e.g. COPD) age 18-64 who ever received an pneumococcal vaccination	NHIS	BRFSS	HP2010
	Process: % of persons age 65 and over who ever received an pneumococcal vaccination	NHIS	BRFSS	NCQA, AMA, HP2010, LHI
	Process: % of institutionalized adults (persons in long-term care or nursing homes) who ever received pneumococcal vaccination	NNHS		HP2010
	Outcome: Hospital admissions for immunization-preventable pneumonia per 100,000 population	HCUP	HCUP	HP2010
Respiratory diseases: Treatment of pneumonia	Process: % of patients with pneumonia who have blood cultures collected before antibiotics are administered	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of patients with pneumonia who receive the initial antibiotic dose within 8 hours of hospital arrival	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of patients with pneumonia who receive the initial antibiotic consistent with current recommendations	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of patients with pneumonia who receive influenza screening or vaccination	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Process: % of patients with pneumonia who receive pneumococcal screening or vaccination	Medicare PRO chart review	Medicare PRO chart review	JCAHO, NQF(draft)
	Outcome: Pneumonia mortality (within 30 days of admission)
Respiratory diseases: Treatment of upper respiratory infection (URI)	Process: % of visits where antibiotic prescribed for sole diagnosis of a common cold, children	NAMCS/ NHAMCS		~HP2010
	Process: % of visits where antibiotic prescribed for sole diagnosis of a common cold, adults	NAMCS/ NHAMCS		~HP2010
Respiratory diseases: Management of asthma	Process: % of people with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma (inhaled corticosteroids)	HEDIS		AMA, NCQA
	Outcome: Hospital admissions for pediatric asthma per 100,000 population under age 18	NHDS, HCUP	HCUP	HP2010, HCUP-QI
	Outcome: Hospital admissions for adult asthma per 100,000 population age 18-64	NHDS, HCUP	HCUP	HP2010, HCUP-QI
Long-term care: Nursing facility care	Chronic care: Weight loss prevalence	MDS	MDS	CMS
	Chronic care: Inadequate pain management	MDS	MDS	CMS
	Chronic care: Late-loss ADL worsening	MDS	MDS	CMS
	Chronic care: Infections prevalence	MDS	MDS	CMS
	Chronic care: Stage 1-4 pressure ulcer prevalence	MDS	MDS	CMS
	Chronic care: Restraint use prevalence	MDS	MDS	CMS
	Post acute care: Failure to improve/manage delirium symptoms	MDS	MDS	CMS
	Post acute care: Inadequate pain management	MDS	MDS	CMS
	Post acute care: Improvement in walking	MDS	MDS	CMS
Long-term care: Home health care	To be determined (plan is to include measures from CMS's public reporting initiative, which is currently under development).

Safety

Topic	Measure	National Data Base^a	State Data Base^a	Consensus Process^b
Complications of care	Selected postoperative complications (composite)	HCUP	HCUP	HCUP-QI
	Selected technical adverse events (composite)	HCUP	HCUP	HCUP-QI
	Technical difficulty with selected procedures (composite)	HCUP	HCUP	HCUP-QI
	Obstetric trauma (composite)	HCUP	HCUP	HCUP-QI
	Birth trauma	HCUP	HCUP	HCUP-QI
	Death in low mortality DRG	HCUP	HCUP	HCUP-QI
	Failure to rescue	HCUP	HCUP	HCUP-QI
	Transfusion reaction	HCUP	HCUP	HCUP-QI
	Foreign body left in body during procedure	HCUP	HCUP	HCUP-QI
	Central line-associated bloodstream infection in ICU patients	NNIS		HP2010
	Central line-associated bloodstream infection in infants weighing 1000 grams or less at birth in intensive care	NNIS		HP2010
Prescribing medications	% of elderly who received potentially inappropriate medications	MEPS
Prescribing medications	% of patients who report that usual source of care asks about Rx from other providers	MEPS
Injuries in nursing facilities	Falls	MDS	MDS
Injuries in nursing facilities	Fractures	MDS	MDS

Timeliness

Topic Condition	Measure	National Data Base^a	State Data Base^a	Consensus Process^b
Basic access	% of persons who report that they have a usual source of medical care, by place of care	NHIS		HP2010
Basic access	% of families that experience difficulties in obtaining care, by reason	MEPS		HP2010
Getting appointments	% of persons who report that they can get an appointment for routine care as soon as they wanted (always, usually, sometimes/never)	MEPS	NCBD
Getting appointments	% of persons who report that they can get care for illness/injury as soon as they wanted (always, usually, sometimes/never)	MEPS	NCBD
Waiting time	ED visits: Average time from arrival to being seen by a physician (separately for emergent, urgent, semi-urgent, and non-urgent visits)	NAMCS/ NHAMCS
	ED visits: % of patients who left without being seen	NAMCS/ NHAMCS
	OP/clinic visits: Average time spent waiting before being seen by doctor	MEPS
	Office visits: Average time spent waiting before being seen by doctor	MEPS

Patient Centeredness

Topic Condition	Measure	National Data Base^a	State Data Base^a
Patient experience of care	% of patients who report that doctor listens carefully (always, usually, sometimes/never), adults and parents of children	MEPS	NCBD
	% of patients who report that doctor explains things clearly (always, usually, sometimes/never), adults and parents of children	MEPS	NCBD
	% of patients who report that doctor showed respect for what you had to say (always, usually, sometimes/never), adults and parents	MEPS	NCBD
	% of patients who report that doctor spent enough time with them (always, usually, sometimes/never), adults and parents of children	MEPS	NCBD

Resource Consumption

Measure	National Data Base^a	State Data Base^a
Total national health expenditures by expenditure type and source of funds	NHA
Per capita health expenditures by source of funds and state	NHA	NHA
% of GDP spent on health - US and OECD countries	WHO
% of gross state product spent on health		NHA

Overall Measures

Measure	National Data Base^a	State Data Base^a
Overall rating of health care received	MEPS	NCBD
Life expectancy (at birth, at age 65)	Vital statistics
Days of activity limitation due to health	NHIS	BRFSS

^a BRFSS=Behavioral Risk Factor Surveillance System;
HCUP = Healthcare Cost and Utilization Project;
HEDIS = Health Plan and Employer Data Information Set;
MEPS = Medical Expenditure Panel Survey;
MDS = Minimum Data Set;
NAMCS = National Ambulatory Medical Care Survey;
NCBD = National CAHPS Benchmarking Database;
NHA = National Health Accounts;
NHANES = National Health and Nutrition Examination Survey;
NHIS = National Health Interview Survey;
NHHCS = National Home Health and Hospice Care Survey;
NHAMCS = National Hospital Ambulatory Medical Care Survey;
NHDS = National Hospital Discharge Survey;
NIS = National Immunization Survey;
NNHS = National Nursing Home Survey;
Vital statistics = National Vital Statistics System, Mortality;
SEER = Surveillance, Epidemiology, and End Results Program;
USRDS = United States Renal Data System;
WHO = World Health Organization;
~ = Approximation of measure from given measure set.

^bAMA = American Medical Association Consortium's core physician performance measures set;
AMA/JCAHO/NCQA = Joint statement on performance measures for the management of diabetes;
CMS = Centers for Medicare & Medicaid Services public reporting initiative;
HCUP-QI = Healthcare Cost and Utilization Project quality indicators (prevention, inpatient, and patient safety indicators);
HP2010 = Healthy People 2010;
JCAHO = Joint Commission for Accreditation of Healthcare Organization's hospital core measures;
LHI = Leading Health Indicators;
NCQA = National Committee for Quality Assurance's HEDIS measure set;
NQF = National Quality Forum hospital quality measures (draft);
~ = Approximation of measure from given measure set.

Current as of July 2002

Internet Citation:

Preliminary Measure Set, National Healthcare Quality Report. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhrq02/premeasures.htm