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Chapter 3: Updating the Framework for the NHQR and NHDR

Future Directions for the National Healthcare Quality and Disparities

Summary

The framework proposed by this committee can be viewed as a building block for AHRQ's national healthcare reports, as it provides a foundation on which to base the reporting of national health care performance. The additional quality components of access, efficiency, care coordination, and health systems infrastructure capabilities should be viewed as areas in which evidence has shown potential for improving quality care, and progress should be made in how to measure the impact of these components on the delivery system. The committee recognizes that some measures for these additional framework components are still in the developmental stage, but encourages AHRQ to foster measure development by highlighting gaps and promoting the research necessary to advance measurement and reporting endeavors. By choosing to identify new framework components for which there are often only developmental measure choices, the Future Directions committee has set a course for looking beyond data availability and encouraging the development of measures and data that may demonstrate greater effectiveness for improving the standard of care.

While the committee recognizes that the national healthcare reports are an inappropriate testbed for the creation of actual measures, it believes that AHRQ can play a role in identifying possible areas for future measure development. The committee encourages AHRQ and other entities to identify or develop impactful measures for each of the eight framework components. Areas of research could include establishing more targeted measures for efficiency, or evaluating the evidence of the quality impact of workforce trained in emerging models of care, such as the integrated systems promoted by the PCMH model. Such exploration could help the national healthcare reports be as responsive as possible to desired or developing areas of performance measurement and reporting.

The expanded portfolio of measures that may result from applying this proposed framework to the national healthcare reports should reflect the needs of a variety of stakeholders but should not be so large as to unduly tax AHRQ's resources. To streamline measure selection for the increased number of framework components, reporting on a measure should occur only after it has been subject to the measure selection process proposed by the committee in Chapter 4. The work required to transition the NHQR and NHDR to report on a potentially different set of measures, as dictated by a national set of priorities and the proposed strategies for measure selection, could be significant. To alleviate some of this burden, the committee recommends additional resources (go to Chapter 7).

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Current as of December 2010
Internet Citation: Chapter 3: Updating the Framework for the NHQR and NHDR: Future Directions for the National Healthcare Quality and Disparities . December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/iomqrdrreport/futureqrdr3b.html