TABLE E-1 Analytic Frameworks Used by the Committee

Analytic Frameworks

Framework Components


Structure → Process → Outcomes

IOM six aims

Safe, effective, patient-centered, timely, efficient, and equitable

FACCT domains of consumer needs

Staying healthy, getting better, living with illness or disability, and coping with end of life

IOM priority areas as expanded by NQFa

Infrastructure: information technology (standardization and capacity); patient safety (including but not limited to health care–acquired infections and medication management and adherence)


Processes of care: care coordination and communication, care at the end of life (focus on congestive heart failure and chronic obstructive pulmonary disease), immunizations (all ages), pain management, self-management/health literacy


Health care conditions: asthma; cancer; pneumonia; depression; diabetes; children with special health care needs; frailty associated with old age (preventing falls and pressure ulcers, maximizing function, and developing advanced-care plans); hypertension; ischemic heart disease; kidney disease; mental illness; obesity; pregnancy, childbirth, and newborn care; stroke; and tobacco dependence (prevention and treatment)

CMS priority chronic conditions for adults 65 and over

Ischemic heart disease; cancer; chronic obstructive pulmonary disease/asthma; stroke, including hypertension; arthritis and nontraumatic joint disorders; diabetes mellitus; dementia, including Alzheimer’s disease; pneumonia; peptic ulcer/dyspepsia; and depression and other mood disorders

aNQF endorsed the IOM’s original 20 priority areas, and added the areas of kidney disease and information technology infrastructure.

(See Figure E-1). Donabedian’s model proposes that each component has a direct influence on the next, as represented by the arrows in the following schematic (Donabedian, 1980):

FIGURE E-1 Donabedian’s model.

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