In its reauthorization legislation, Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce an annual report on health care quality in the United States (Public Law 106-129). The National Healthcare Quality Report (NHQR) will include a broad set of performance measures that will be used to monitor the Nation's progress toward improved health care quality.
Select for Preliminary Measure Set, Comment, Update on NHQR.
Contents
Establish Conceptual Framework
Identify Pool of Candidate Measures
Flesh Out Conceptual Framework
Identify Preliminary Measure Set
Obtain Input on Preliminary Measure Set
Identify Final Measure Set for First Report
More Information
How to Provide Comments
AHRQ is following a multistep process to identify a measure set for the first National Healthcare Quality Report (NHQR). An overview follows.
AHRQ contracted with the Institute of Medicine (IOM) to work on a conceptual framework for the NHQR. The IOM formed a 14-member committee of leading experts in quality and quality measurement, chaired by Drs. William Roper and Arnold Epstein. The committee commissioned papers, held multiple meetings to discuss alternative conceptual models, and heard testimony from a wide variety of groups. Their recommendations for the NHQR are included in Envisioning the National Health Care Quality Report.
That report recommends a conceptual framework that can be depicted as a matrix including both dimensions of care (e.g., effectiveness, safety, timeliness, patient centeredness, equity) and patient needs (e.g., staying healthy, getting better, living with illness or disability, coping with the end of life). The conceptual framework is below.
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Components of Health Care Quality |
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Health care needs |
Effectiveness |
Safety |
Timeliness |
Patient centeredness |
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Staying healthy |
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Getting better |
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Living with illness or disability |
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End of life care |
AHRQ formed an interagency workgroup to identify candidate measures for the NHQR. The workgroup includes representatives from AHRQ, the National Center for Health Statistics, the Centers for Medicare and Medicaid Services, the National Institutes of Health, and the Office of the Assistant Secretary for Planning and Evaluation. The workgroup developed a "call for measures" that was sent to all relevant Federal agencies. The IOM issued a complementary call for measures to the private sector. About 600 measures were submitted for consideration in response to these calls.
In Crossing the Quality Chasm, the IOM recommended that the Department of Health and Human Services identify a few priority areas for focused quality measurement and improvement. AHRQ is now working with the IOM to develop a process for identifying priority areas. Ultimately, measurement in the NHQR is expected to be aligned with the priority areas established through this process. However, these areas will not be determined in time for production of the first NHQR.
Therefore, the interagency workgroup identified a set of interim priority areas for the first report based on selected priorities established in Healthy People 2010. These interim priority areas were used to begin fleshing out the conceptual framework. The "effectiveness" dimension of the framework was broken down by priority area and basic categories of care were identified.
For example, one priority area is heart disease. In thinking about the effectiveness of care for heart disease, one could identify categories of care having to do with staying healthy (e.g., screening for risk factors), getting better (e.g., treatment of acute myocardial infarction [AMI]), and living with illness and disability (e.g., management of hypertension). The "effectiveness" column of the IOM's conceptual matrix was fleshed out in this way for each interim priority area. The remaining columns of IOM's matrix (i.e., safety, timeliness, patient centeredness) were also fleshed out by identifying basic categories of care. However, since current data do not support priority area-specific measurement in these dimensions, the categories are more cross-cutting in nature. Select for the detailed conceptual framework.
The interagency workgroup mapped the candidate measures (see above) into the fleshed-out conceptual framework. The measures within each category of care were evaluated for inclusion in two parts:
AHRQ is seeking input on the preliminary measure set from stakeholders and other interested parties. This will include a public hearing sponsored by the National Committee for Vital and Health Statistics and input from other key technical advisory groups. Anyone interested in the NHQR may provide comments to AHRQ. AHRQ is especially interested in input on the individual measures included and the overall balance, comprehensiveness, and robustness of the measure set. Select for details on providing comments.
While obtaining input, AHRQ will begin relevant data analysis for the measures
in the preliminary measure set. Based on the input and the results of analyses,
final decisions will be made on which measures will be included in the first
NHQR. AHRQ hopes to obtain agreement on the final measure set by November 2002.
This decisionmaking process will involve broad input from throughout the Department
of Health and Human Services.
Equity is another dimension of care included in the IOM's conceptual framework. It is not explicitly reflected in the matrix because it cuts across all of the cells. Where possible, we plan to look at breakdowns of measures of effectiveness, safety, timeliness, and patient centeredness by sociodemographic group, insurance status, and the like. The NHQR will explore these differences, but they will be pursued in depth in a companion report, The National Healthcare Disparities Report.
In its Envisioning report, the IOM did not recommend that AHRQ explicitly examine the efficiency of care in the NHQR. Other reviewers have commented that some sense of resource consumption is needed in the report to frame the description of quality. The preliminary measure set thus includes selected measures of resource consumption that will be reported along with the other measures of quality. The further development of efficiency measures is under discussion for future reports.
The reporting effort for the NHQR will be designed to serve the needs of different audiences. Through audience research during the NHQR development effort, it has become clear that there are at least two distinct types of users of a report like this. The first group is interested in the bottom line and want the basic news without a lot of detail. Busy policymakers frequently fall into this category. The second are "analysts" who want the full detail of what was done and what was found. They especially tend to want access to detailed tables of results that they can examine in depth themselves.
The report to Congress will be designed to meet the needs of both of these audiences. It will include a short summary report that highlights the key points from the analysis (for the policy audience) and appendices that include technical specifications and detailed tables for all of the measures (for the analyst audience). As time goes on, additional reporting products are planned to serve the needs of additional audiences such as the public.
The conceptual framework and interim priority areas chosen represent one of many legitimate frameworks that could be adopted. One alternative suggested is to organize around type of provider (ambulatory, hospital, nursing facility, etc.). To aid in the use of the report, an appendix is planned that will provide a crosswalk of the measures to alternative frameworks such as this. The appendix will also include references to other important measurement efforts (e.g., AHRQ Quality Indicators).
AHRQ requests your input on the preliminary measure set. Please make comments or suggestions by September 18, 2002 (deadline extended), to:
Ed Kelley, Ph.D.
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality
Phone: (301) 427-1321
E-mail: EKelley@ahrq.gov
Current as of July 2002
Internet Citation:
NHQR Preliminary Measure Set. Background. July 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhqr02/nhqrprelim.htm
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