the spectrum of health care conditions; and the capability for change across a range of health care settings and providers.
NQF subsequently added two areas to the IOM’s original list of 20—kidney disease and information technology infrastructure—and endorsed the resulting list of 22 areas.
A collaborative effort involving CMS, the Agency for Healthcare Research and Quality (AHRQ), the Food and Drug Administration, and other stakeholders recently identified 10 priority conditions (listed in Table E-1) that account for the majority of disease burden and service utilization for the Medicare population aged 65 and older (AHRQ, 2004). AHRQ has launched a $15 million initiative, with funding authorized under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, supporting research to investigate the effectiveness of interventions targeting these conditions, including prescription drugs. As a result of these efforts, CMS hopes ultimately to help providers and patients make more informed health care decisions.
The committee’s analysis involved a series of steps that are listed below sequentially, although the actual process was far more iterative than linear:
Map measures from leading performance measure sets to a two-dimensional matrix.
Assess the current state of performance measurement and identify gaps.
Review measures in the matrix against the priority clinical areas.
To guide the selection of performance measures, the committee adopted a matrix building upon the IOM six aims and the FACCT domains representing patients’ needs across the lifespan, as described above (FACCT, 1999). More than 800 measures of structure, process, and outcomes from more than 50 leading measurement sets were pooled and mapped against this two-dimensional matrix. When appropriate, the individual measures were maintained within the context of the original measure sets.