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 Condition | Measure | National Data Basea | State Data Basea | Consensus Processb |
|---|---|---|---|---|
| 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 |
| 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 |
| 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 | |
| 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 | ||
| 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 Basea | State Data Basea | Consensus Processb |
|---|---|---|---|---|
| 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 | ||
| % of patients who report that usual source of care asks about Rx from other providers | MEPS | |||
| Injuries in nursing facilities | Falls | MDS | MDS | |
| Fractures | MDS | MDS |
Timeliness
| Topic Condition | Measure | National 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 care | NHIS | HP2010 | |
| % 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 | |
| % 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 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 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 Basea | State Data Basea | Consensus Processb |
|---|---|---|---|
| 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 Basea | State Data Basea | Consensus Processb |
|---|---|---|---|
| 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. https://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://archive.ahrq.gov/research/findings/nhqrdr/nhqr02/premeasures.html
5600 Fishers Lane Rockville, MD 20857