measurement that might have a high impact for improving population health and providing value for the investment in care, but for which effectiveness research, measurement development, or sufficient data collection are still needed. Examples include the provision and management of oncology care (not just prevention) and surgical procedures for specific specialties (e.g., orthopedic surgery measures), both of which were brought to the committee’s attention as high-cost items that patients, business, and insurers want to ensure are delivered in the most effective and efficient manner. While there may be some validated measures for these topics, the measures often lack either intensive data collection or sufficient ability to support analyses for disparities, and therefore have not been well represented in national reporting efforts.

A review of quality performance measurement in California found a lack of measures in use for mental health, hospital-acquired infections, obesity, and dental care (University of California at Davis, 2008). Given the recent attention to poor oral health (e.g., reported deaths in children due to untreated dental disease) and documented oral health disparities (AHRQ, 2003), additional or more targeted measures could be developed.1 The Children’s Health Insurance Program Reauthorization Act (CHIPRA)2 may provide one mechanism for collecting data, for instance, on a children’s dental care measure. CHIPRA required the Secretary of HHS to recommend a set of children’s health care quality measures for voluntary use by Medicaid, the Children’s Health Insurance Program (CHIP), and health insurance issuers and managed care entities that enter into contracts with Medicaid or CHIP programs. The initial set of measures, proposed in January 2010, includes one dental measure: “Total eligibles receiving preventive dental services” (HHS Office of the Secretary, 2009). If AHRQ expands reporting on the priority population of children, the National Survey of Children’s Health (NSCH) could provide data on children who received needed mental health treatment, a measurement area on which AHRQ does not currently report, but that AHRQ may determine to be of high impact.3

Efforts to identify developmental performance measures for health are currently being undertaken by Healthy People 2020. A draft of Healthy People 2020’s objectives includes several quality indicators identified as developmental, signifying that these measures are still being assessed for their validity and reliability for reporting (HHS, 2009). The National Priorities Partnership (NPP)—a collaborative of 32 major national organizations interested in transformational change in the U.S. health care system convened by the National Quality Forum (NQF)—promotes aspirational measurement for areas where improvement is believed to have potential for high health impact. Although the NPP has identified a number of NQF-endorsed measures compatible with its priorities, for many measures, little or no data are available on a national scale. Work is under way at the NQF to provide a roadmap of measures available in the short- and long-term to support documentation and build consensus among provider, payer, consumer, and community groups for these potential areas and measures.4 These efforts are of interest because they relate to the priorities proposed by the Future Directions committee (see Box 2-3 in Chapter 2).


Just as Chapter 3 did not go into the discussion of the care components that were included in the original framework for the NHQR and NHDR (i.e., effectiveness, safety, timeliness, patient-centeredness), this appendix does not present additional suggestions for reporting measures in those areas. The following sections address measure reporting possibilities for the new components of access, efficiency, care coordination, and health care systems infrastructure. Equity and value are crosscutting dimensions that were also added to the framework but do not have specific measures associated with them, and so are not addressed in this appendix. The committee offers


In the NHQR and NHDR, AHRQ currently reports on three dental care measures: percent of children age 2-17 with a dental visit in the past year (note: this measure is reported in the NHQR in alternate years); people who were unable to get or delayed in getting needed dental care in the past 12 months; people who were unable to get or delayed in getting needed dental care due to financial or insurance reasons (note: these two latter measures are usually reported as part of composite measures in the NHDR). Another measure, “People who had a dental visit in the calendar year,” is reported in an online appendix to the reports.


Children’s Health Insurance Program Reauthorization Act, Public Law 111-3, 111th Cong., 1st sess. (January 6, 2009).


AHRQ and CMS are implementing the quality provisions of CHIPRA and have identified mental health and substance abuse services for children as a priority area for pediatric quality measurement. A proposed core set of children’s health care quality measures for use by Medicaid and CHIP programs includes a measure on follow-up after hospitalization for mental illness (HHS Office of the Secretary, 2009).


Personal communication, Karen Adams, National Priorities Partnership, National Quality Forum, November 17, 2009.

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