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.
|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
|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
Breast and cervical cancer
Child and adult immunizations
End-stage renal disease
HIV and AIDS
Maternal and child health
Nursing home and home health care
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.
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.
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).