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.


Table E-1

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
  1. Diseases of the heart
  2. Malignant neoplasms
  3. Cerebrovascular diseases
  4. Chronic lower respiratory diseases
  5. Accidents (unintentional injuries)
  6. Diabetes mellitus
  7. Influenza and pneumonia
  8. Alzheimer's disease
  9. Nephritis, nephritic syndrome, and nephrosis
  10. Septicemia
  11. Intentional self-harm (suicide)
  12. Chronic liver disease and cirrhosis
  13. Essential (primary) hypertension and hypertensive renal disease
  14. Parkinson's disease
  15. Pneumonitis due to solids and liquids
  1. Arthritis or rheumatism
  2. Back or spine problem
  3. Heart trouble/hardening of the arteries
  4. Lung or respiratory problem
  5. Deafness or hearing problem
  6. Limb/extremity stiffness
  7. Mental or emotional problem
  8. Diabetes
  9. Blindness or vision problem
  10. Stroke
  11. Broken bone/fracture
  12. Mental retardation
  13. Cancer
  14. High blood pressure
  15. Head or spinal cord injury
  1. Heart disease
  2. Back problems
  3. Arthritis
  4. Asthma
  5. Diabetes
  6. Mental disorders
  7. Disorders of the eye
  8. Learning disabilities and mental retardation
  9. Cancer
  10. Visual impairments
  1. Heart conditions
  2. Trauma
  3. Cancer
  4. Mental disorders
  5. Pulmonary conditions
  1. Newborn infant
  2. Hardening of the heart arteries (coronary atherosclerosis)
  3. Pneumonia
  4. Congestive heart failure
  5. Chest pain
  6. Trauma to vulva (external female genitals) and perineum (area between anus and vagina) due to child
  7. Heart attack (acute myocardial infaraction)
  8. Cardiac dysrhythmias (irregular heart beat)
  9. Other maternal complications of birth and puerperium (period after childbirth)

Table E-1 (continued)

IOM, 2003 HHS, 2004 NHIS, 2002 NHIS 2002 NHIS 2002 NHQR, 2005
NHDR, 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

  1. Hypertension
  2. HIV
  3. Diabetes mellitus
  4. Homicide
  5. Atherosclerotic disease
  1. Ischemic heart disease
  2. Lung cancer
  3. Cerebrovascular disease
  4. Congestive heart disease
  5. Pneumonia
  6. Lung disease
  7. Atherosclerotic disease
  8. Diabetes mellitus
  9. Hypertension
  10. Colon cancer

Infant mortality

Breast and cervical cancer


HIV infections/AIDS

Child and adult immunizations



End-stage renal disease

Heart disease


Maternal and child health

Respiratory diseases

Nursing home and home health care

Patient safety



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.

HCUP (Healthcare Cost and Utilization Project). 2005. Hospitalizations in the United States, 2002. Rockville, MD: Agency for Healthcare Research and Quality.

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).

IOM (Institute of Medicine). 2003. Priority areas for national action: Transforming health care quality. Washington, DC: The National Academies Press.

Krause, L.E., S. Stoddard, and D. Gilmartin. Chartbook on disability in the United States, 1996. Washington, DC: U.S. National Institute on Disability and Rehabilitation Research.

NVSS (National Vital Statistics System). 2005. Deaths: Leading causes for 2002. Hyattsville, MD: National Center for Health Statistics.

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Page last reviewed October 2014
Page originally created September 2012
Internet Citation: E. HHS Interagency Workgroup for the NHQR and NHDR. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/iomqrdrreport/futureqrdrape.html