Preliminary Measure Set

National Healthcare Quality Report, 2002

The National Healthcare Disparities Report (NHDR) tracks disparities in both quality of and access to health care in the United States for both the general population and for AHRQ's congressionally designated priority populations. This is the text version of the NHDR 2008 slide presentation.

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.


Contents

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 ConditionMeasureNational
Data Basea
State
Data Basea
Consensus
Processb
Cancer: Screening for breast cancerProcess: % of women (age 40 and over, 50-69) who report they had a mammogram within the past 2 yearsNHISBRFSSNCQA, HP2010, AMA
Outcome: % of breast cancers diagnosed at late stageSEER  
Cancer: Screening for cervical cancerProcess: % of women (18 and over) who report that they had a Pap smear within the past 3 yearsNHISBRFSSNCQA, HP2010
Outcome: % of cervical cancers diagnosed at late stageSEER  
Cancer: Screening for colorectal cancerProcess: % of men and women (50 and older) who report they ever had a flexible sigmoidoscopy/colonoscopyNHISBRFSSHP2010
Process: % of men and women (50 and over) who report they had a fecal occult blood test (FOBT) within the past 2 yearsNHISBRFSSHP2010
Outcome: % of colorectal cancers diagnosed at late stageSEER  
Cancer: Cancer treatmentOutcome: Cancer deaths per 100,000 persons per year for all cancersVital statisticsVital statisticsHP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, prostate cancerVital statisticsVital statisticsHP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, breast cancerVital statisticsVital statisticsHP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, lung cancerVital statisticsVital statisticsHP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, colorectal cancerVital statisticsVital statisticsHP2010
Cancer: Palliative careProcess: % of people who died of cancer who received hospice careNHHCS  
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 transplantsUSRDSUSRDS 
Outcome: Average urea reduction ratioUSRDSUSRDSCMS
Outcome: Average hematocritUSRDSUSRDSCMS
Outcome: First year patient death rates, by treatment modalityUSRDSUSRDSCMS
Diabetes: Management of diabetesProcess: % of people with diabetes with condition diagnosedNHANES HP2010
Process: % of adults with diabetes who had a hemoglobin A1c measurement at least once in past yearMEPSBRFSSAMA/JCAHO/
NCQA,
HP2010
Process: % of patients with diabetes who had a lipid profile in past two yearsMEPS AMA/JCAHO/
NCQA
Process: % of adults with diabetes who had a retinal eye examination in past yearMEPSBRFSSAMA/JCAHO/
NCQA,
HP2010
Process: % of adults with diabetes who had a foot examination in past yearMEPSBRFSSAMA/JCAHO/
NCQA,
HP2010
Process: % of adults with diabetes who had an influenza immunization in past yearMEPSBRFSSAMA/JCAHO/
NCQA
Outcome: % of adults with diabetes with HbA1c level under controlNHANES AMA/JCAHO/
NCQA
Outcome: % of adults with diabetes with lipid level under controlNHANES AMA/JCAHO/
NCQA
Outcome: % of adults with diabetes with blood pressure under controlNHANES AMA/JCAHO/
NCQA
Outcome: Hospital admissions for uncontrolled diabetes per 100,000 populationHCUPHCUPHP2010,
HCUP-QI
Outcome: Hospital admissions for short term complications of diabetes per 100,000 populationHCUPHCUPHCUP-QI
Outcome: Hospital admissions for long term complications of diabetes per 100,000 populationHCUPHCUPHCUP-QI
Outcome: Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 populationNHDS, HCUPHCUPHP2010,
HCUP-QI
Heart disease: Screening for high blood pressureProcess: % of people age 21 and over having blood pressure checked within past 2 yearsNHISBRFSS 
Heart disease: Screening for high cholesterolProcess: % of men (age 35-65) and women (age 45-65) receiving cholesterol measurement within past 5 yearsNHISBRFSSHP2010
Heart disease: Counseling on risk factorsProcess: % of smokers receiving advice to quit smokingMEPSBRFSSNCQA, HP2010, AMA
Heart disease: Treatment of acute myocardial infarction (AMI)Process: % of AMI patients administered aspirin within 24 hours of admissionMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NCQA,
NQF(draft)
Process: % of AMI patients with aspirin prescribed at dischargeMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients administered beta blocker within 24 hours of admissionMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients with beta blocker prescribed at dischargeMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at dischargeMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients given smoking cessation counseling while hospitalizedMedicare 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 blockMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Outcome: AMI mortality (within 30 days of admission)Medicare claimsMedicare claims~JCAHO,
NQF(draft)
Heart disease: Treatment of acute heart failureProcess: % of heart failure patients having evaluation of left ventricular ejection fractionMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at dischargeMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Outcome: Mortality after acute heart failure (within 30 days of admission)Medicare claimsMedicare claims~JCAHO,
NQF(draft)
Heart disease: Management of hypertensionOutcome: % of people with hypertension who have blood pressure under controlNHANES NCQA, HP2010
Heart disease: Management of congestive heart failure (CHF)Outcome: Hospital admissions for congestive heart failure (CHF) per 100,000 populationNHDS, HCUPHCUPHP2010,
HCUP-QI
HIV/AIDS: AIDS preventionOutcome: 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/AIDSProcess: % of HIV-infected persons receiving highly active antiretroviral therapy (HAART)Adult Spectrum of Disease Survey HP2010
Outcome: HIV-infection deaths per 100,000 populationVital statisticsVital statisticsHP2010
HIV/AIDS: Palliative careProcess: % of people who died of AIDS who received hospice careNHHCS  
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 careProcess: % of pregnant women receiving prenatal care in first trimesterVital StatisticsVital StatisticsHP2010, LHI
Outcome: % of liveborn infants with low and very low birthweight (less than 2,500 grams, less than 1,500 grams)Vital StatisticsVital StatisticsHP2010
Outcome: Infant mortality per 1,000 live births, by birth weightVital StatisticsVital StatisticsHP2010, JCAHO
Outcome: Maternal deaths per 100,000 live birthsVital StatisticsVital StatisticsHP2010
[See Safety measures for complications of obstetric care]   
Maternal and child health: Childhood immunizationsProcess: % of children 19-35 months who received all recommended vaccinesNISNISNCQA, HP2010,
LHI
Process: % of children 19-35 months who received 4 doses of DPaT vaccineNISNISNCQA, HP2010
Process: % of children 19-35 months who received 3 doses of polio vaccineNISNISNCQA, HP2010
Process: % of children 19-35 months who received 1 dose of MMR vaccineNISNISNCQA, HP2010
Process: % of children 19-35 months who received 3 doses of Hib vaccineNISNISNCQA, HP2010
Process: % of children 19-35 months who received 3 doses of hepatitis B vaccineNISNISNCQA, HP2010
Process: % of children 19-35 months who received 1 dose of varicella vaccineNISNISNCQA, HP2010
Maternal and child health: Adolescent immunizationsProcess: % of adolescents (age 13-15) reported to have received 3 or more doses of hepatitis B vaccineNHIS HP2010
Process: % of adolescents (age 13-15) reported to have received 2 or more doses of MMR vaccineNHIS HP2010
Process: % of adolescents (age 13-15) reported to have received 1 or more doses of tetanus-diphtheria boosterNHIS HP2010
Process: % of adolescents (age 13-15) reported to have received 3 or more doses of varicella vaccineNHIS HP2010
Maternal and child health: Childhood dental careProcess: Time since last dental contact (1 year or less, more than 1 year but not more than 3 years, more than 3 years)NHIS  
Outcome: % of children with untreated dental decayNHANES HP2010
Maternal and child health: Treatment of pediatric gastroenteritisOutcome: Hospital admissions for pediatric gastroenteritis per 100,000 population less than 18 years of ageHCUPHCUPHCUP-QI
Mental health: Treatment of depressionProcess: % of adults with depression who received treatmentNHSDANHSDAHP2010, LHI
Process: % of adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phaseHEDIS 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 phaseHEDIS 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 treatmentHEDIS NCQA
Outcome: Deaths due to suicide per 100,000 populationVital StatisticsVital StatisticsHP2010
Respiratory diseases: Influenza immunizationProcess: % of high risk persons (e.g. COPD) age 18-64 who received an influenza vaccination in the past 12 monthsNHISBRFSSHP2010
Process: % of persons age 65 and over who received an influenza vaccination in the past 12 monthsNHISBRFSSNCQA, HP2010,
LHI
Process: % of institutionalized adults (persons in long-term care or nursing homes) who received influenza vaccination in past 12 monthsNNHS HP2010
Outcome: Hospital admissions for immunization-preventable influenza per 100,000 populationHCUPHCUPHP2010
Respiratory diseases: Pneumococcal immunizationProcess: % of high risk persons (e.g. COPD) age 18-64 who ever received an pneumococcal vaccinationNHISBRFSSHP2010
Process: % of persons age 65 and over who ever received an pneumococcal vaccinationNHISBRFSSNCQA, AMA,
HP2010, LHI
Process: % of institutionalized adults (persons in long-term care or nursing homes) who ever received pneumococcal vaccinationNNHS HP2010
Outcome: Hospital admissions for immunization-preventable pneumonia per 100,000 populationHCUPHCUPHP2010
Respiratory diseases: Treatment of pneumoniaProcess: % of patients with pneumonia who have blood cultures collected before antibiotics are administeredMedicare 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 arrivalMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive the initial antibiotic consistent with current recommendationsMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive influenza screening or vaccinationMedicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive pneumococcal screening or vaccinationMedicare 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, childrenNAMCS/
NHAMCS
 ~HP2010
Process: % of visits where antibiotic prescribed for sole diagnosis of a common cold, adultsNAMCS/
NHAMCS
 ~HP2010
Respiratory diseases: Management of asthmaProcess: % 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 18NHDS, HCUPHCUPHP2010,
HCUP-QI
Outcome: Hospital admissions for adult asthma per 100,000 population age 18-64NHDS, HCUPHCUPHP2010,
HCUP-QI
Long-term care: Nursing facility careChronic care: Weight loss prevalenceMDSMDSCMS
Chronic care: Inadequate pain managementMDSMDSCMS
Chronic care: Late-loss ADL worseningMDSMDSCMS
Chronic care: Infections prevalenceMDSMDSCMS
Chronic care: Stage 1-4 pressure ulcer prevalenceMDSMDSCMS
Chronic care: Restraint use prevalenceMDSMDSCMS
Post acute care: Failure to improve/manage delirium symptomsMDSMDSCMS
Post acute care: Inadequate pain managementMDSMDSCMS
Post acute care: Improvement in walkingMDSMDSCMS
Long-term care: Home health careTo be determined (plan is to include measures from CMS's public reporting initiative, which is currently under development).   

Safety

TopicMeasureNational
Data Basea
State
Data Basea
Consensus
Processb
Complications of careSelected postoperative complications (composite)HCUPHCUPHCUP-QI
Selected technical adverse events (composite)HCUPHCUPHCUP-QI
Technical difficulty with selected procedures (composite)HCUPHCUPHCUP-QI
Obstetric trauma (composite)HCUPHCUPHCUP-QI
Birth traumaHCUPHCUPHCUP-QI
Death in low mortality DRGHCUPHCUPHCUP-QI
Failure to rescueHCUPHCUPHCUP-QI
Transfusion reactionHCUPHCUPHCUP-QI
Foreign body left in body during procedureHCUPHCUPHCUP-QI
Central line-associated bloodstream infection in ICU patientsNNIS HP2010
Central line-associated bloodstream infection in infants weighing 1000 grams or less at birth in intensive careNNIS HP2010
Prescribing medications% of elderly who received potentially inappropriate medicationsMEPS  
% of patients who report that usual source of care asks about Rx from other providersMEPS  
Injuries in nursing facilitiesFallsMDSMDS 
FracturesMDSMDS 

Timeliness

Topic ConditionMeasureNational
Data Basea
State
Data Basea
Consensus
Processb
Basic access% of persons who report that they have a usual source of medical care, by place of careNHIS HP2010
% of families that experience difficulties in obtaining care, by reasonMEPS 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)MEPSNCBD 
% of persons who report that they can get care for illness/injury as soon as they wanted (always, usually, sometimes/never)MEPSNCBD 
Waiting timeED 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 seenNAMCS/
NHAMCS
  
OP/clinic visits: Average time spent waiting before being seen by doctorMEPS  
Office visits: Average time spent waiting before being seen by doctorMEPS  

Patient Centeredness

Topic ConditionMeasureNational
Data Basea
State
Data Basea
Consensus
Processb
Patient experience of care% of patients who report that doctor listens carefully (always, usually, sometimes/never), adults and parents of childrenMEPSNCBD 
% of patients who report that doctor explains things clearly (always, usually, sometimes/never), adults and parents of childrenMEPSNCBD 
% of patients who report that doctor showed respect for what you had to say (always, usually, sometimes/never), adults and parentsMEPSNCBD 
% of patients who report that doctor spent enough time with them (always, usually, sometimes/never), adults and parents of childrenMEPSNCBD 

Resource Consumption

MeasureNational
Data Basea
State
Data Basea
Consensus
Processb
Total national health expenditures by expenditure type and source of fundsNHA  
Per capita health expenditures by source of funds and stateNHANHA 
% of GDP spent on health - US and OECD countriesWHO  
% of gross state product spent on health NHA 

Overall Measures

MeasureNational
Data Basea
State
Data Basea
Consensus
Processb
Overall rating of health care receivedMEPSNCBD 
Life expectancy (at birth, at age 65)Vital statistics  
Days of activity limitation due to healthNHISBRFSS 

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


 

Current as of May 2005
Internet Citation: Preliminary Measure Set: National Healthcare Quality Report, 2002. May 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqr02/premeasures.html