In its reauthorization legislation, Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce an annual report on health care disparities in the United States (Public Law 106-129). The National Healthcare Disparities Report (NHDR) includes a broad set of performance measures that can be used to monitor the Nation's progress toward improved health care quality for all Americans. The following briefly summarizes the original NHDR measures development process.
Because the NHDR and the National Healthcare Quality Report (NHQR) have been designed as companion reports, they use identical measures of health care quality—i.e., indicators of effectiveness, safety, timeliness, and patient centeredness—to the extent possible with available data. In addition to examining disparities in quality of care, the NHDR also examines disparities in access to health care.
Select for 2003 NHDR Access Measures to view the final access to care measures for the first NHDR.
Organizations Involved
Conceptual Framework
Comments on Measures for the First NHDR
Multiple Reporting Products
Many organizations worked with AHRQ to help develop the measure set, conceptual framework, and products for the first National Healthcare Disparities Report (NHDR). These groups include:
AHRQ formed the NHDR Data Group, an internal committee comprised of staff with expertise in health care disparities and data analysis. In its weekly meetings, these staff members focused on:
The NHDR Interagency Workgroup of the Department of Health and Human Services (HHS) includes representatives from:
This group, in its monthly meetings, provided invaluable advice and comments on draft definitions and measures and identified new data sources and measures for inclusion in the NHDR.
AHRQ contracted with the Institute of Medicine (IOM) to provide guidance for the NHDR. The IOM formed the Committee on Guidance for Designing a National Healthcare Disparities Report, which was comprised of 13 leading experts in health care disparities from across the country.
Chaired by Dr. Sheldon Greenfield, the committee commissioned papers, held public meetings, and heard testimony from a wide variety of groups including:
The IOM committee's recommendations were published in Guidance for the National Healthcare Disparities Report in September 2002. For more information, go to the IOM's Disparities Web site.
Because high quality care is critical to eliminating health care disparities, the NHDR benefited greatly from the work being done on the National Healthcare Quality Report by AHRQ staff. AHRQ also acknowledges the work conducted by members of NHQR's Interagency Workgroup.
The Interagency Workgroups for both the NHDR and the NHQR continue to provide advice on data and measures development for the reports.
The NHDR is built on the conceptual framework that the IOM developed for AHRQ's congressionally mandated National Healthcare Quality Report. This framework can be visualized as a matrix, relating dimensions of care (e.g., access, utilization, cost, and quality) to patient needs (e.g., staying healthy, getting better, living with illness or disability, coping with the end of life).
Select for Conceptual Framework (66 KB).
In addition to the NHQR measures, AHRQ staff explored data and measures from a wide variety of sources. AHRQ also reviewed and accepted suggestions for possible databases and specific measures that were submitted by the public in response to a Federal Register notice published on June 5, 2002.
AHRQ sought input on the preliminary measure set for the first NHDR from stakeholders and other interested parties through December 13, 2002. Of special interest to the agency was input on the individual measures included and the overall balance, comprehensiveness, and robustness of the measure set. While obtaining input, AHRQ began relevant data analysis for the measures in the preliminary measure set. Based on the input and the results of analyses, and with broad input from throughout HHS, final decisions were made on which measures would be included in the first NHDR.
AHRQ conducted audience research to identify the needs of potential audiences in an effort to develop a final product that meets those needs. Results indicated two main audience groups:
The 2003 report to Congress was designed to meet the needs of both audiences. It included a short summary report that highlights the key points from the analysis (for the policy audience) and appendixes that include technical specifications and detailed tables for all of the measures (for the analyst audience). All appendixes, as well as full report text, are available on AHRQ's QualityTools Web site.
Current as of May 2005
Internet Citation:
National Healthcare Disparities Report. Background on the Measures Development Process. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhdr02/nhdrprelim.htm
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