Appendix 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 |
- Diseases of the heart
- Malignant neoplasms
- Cerebrovascular diseases
- Chronic lower respiratory diseases
- Accidents (unintentional injuries)
- Diabetes mellitus
- Influenza and pneumonia
- Alzheimer's disease
- Nephritis, nephritic syndrome, and nephrosis
- Septicemia
- Intentional self-harm (suicide)
- Chronic liver disease and cirrhosis
- Essential (primary) hypertension and hypertensive renal disease
- Parkinson's disease
- Pneumonitis due to solids and liquids
|
- Arthritis or rheumatism
- Back or spine problem
- Heart trouble/hardening of the arteries
- Lung or respiratory problem
- Deafness or hearing problem
- Limb/extremity stiffness
- Mental or emotional problem
- Diabetes
- Blindness or vision problem
- Stroke
- Broken bone/fracture
- Mental retardation
- Cancer
- High blood pressure
- Head or spinal cord injury
|
- Heart disease
- Back problems
- Arthritis
- Asthma
- Diabetes
- Mental disorders
- Disorders of the eye
- Learning disabilities and mental retardation
- Cancer
- Visual impairments
|
- Heart conditions
- Trauma
- Cancer
- Mental disorders
- Pulmonary conditions
|
- Newborn infant
- Hardening of the heart arteries (coronary atherosclerosis)
- Pneumonia
- Congestive heart failure
- Chest pain
- Trauma to vulva (external female genitals) and perineum (area between anus and vagina) due to child
- Heart attack (acute myocardial infaraction)
- Cardiac dysrhythmias (irregular heart beat)
- 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 |
- Hypertension
- HIV
- Diabetes mellitus
- Homicide
- Atherosclerotic disease
|
- Ischemic heart disease
- Lung cancer
- Cerebrovascular disease
- Congestive heart disease
- Pneumonia
- Lung disease
- Atherosclerotic disease
- Diabetes mellitus
- Hypertension
- Colon cancer
|
Infant mortality
Breast and cervical cancer
Diabetes
HIV infections/AIDS
Child and adult immunizations |
Cancer
Diabetes
End-stage renal disease
Heart disease
HIV and AIDS
Maternal and child health
Respiratory diseases
Nursing home and home health care
Patient safety
Timeliness
Patient-centeredness |
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.
References
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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