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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 (see 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 (see 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.
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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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
1. Diseases of the heart
1. Arthritis or rheumatism
1. Heart disease
1. Heart conditions
1. Newborn infant
2. Malignant neoplasms
2. Back or spine problem
2. Back problems
2. Trauma
2. Hardening of the heart arteries (coronary atherosclerosis)
3. Cerebrovascular diseases
3. Heart trouble / hardening of the arteries
3. Arthritis
3. Cancer
3. Pneumonia
4. Chronic lower respiratory diseases
4. Lung or respiratory problem
4. Asthma
4. Mental disorders
4. Congestive heart failure
5. Accidents (unintentional injuries)
5. Deafness or hearing problem
5. Diabetes
5. Pulmonary conditions
5. Chest pain
6. Diabetes mellitus
6. Limb / extremity stiffness
6. Mental disorders
6. Trauma to vulva (external female genitals) and perineum (area between anus and vagina) due to childbirth
7. Influenza and pneumonia
7. Mental or emotional problem
7. Disorders of the eye
7. Heart attack (acute myocardial infarction)
8. Alzheimer’s disease
8. Diabetes
8. Learning disabilities and mental retardation
8. Cardiac dysrhythmias (irregular heart beat)
9. Nephritis, nephritic syndrome, and nephrosis
9. Blindness or vision problem
9. Cancer
9. Other maternal complications of birth and puerperium (period after childbirth)
10. Septicemia
10. Stroke
10. Visual impairments
11. Intentional self-harm (suicide)
11. Broken bone/fracture
12. Chronic liver disease and cirrhosis
12. Mental retardation
13. Essential (primary) hypertension and hypertensive renal disease
13. Cancer
14. Parkinson’s disease
14. High blood pressure
15. Pneumonitis due to solids and liquids
15. Head or spinal cord injury
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.
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IOM, 2003
HHS, 2004
NHIS, 2002
NHIS, 2002
NHIS, 2002
NHQR/NHDR 2005
Priority areas for quality improvement
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
Reduce behavioral and other factors that contribute to the development of chronic diseases
1. Hypertension
1. Ischemic heart disease
Infant mortality
Cancer
Children with special health care needs
Reduce the incidence of sexually transmitted diseases and unintended pregnancies
2. HIV
2. Lung cancer
Breast and cervical cancer
Diabetes
Diabetes—focus on appropriate management of early disease
Increase immunization rates among adults and children
3. Diabetes mellitus
3. Cerebrovascular disease
Diabetes
End-stage renal disease
End of life with advanced organ system failure—focus on congestive heart failure and chronic obstructive pulmonary disease
Reduce substance abuse
4. Homicide
4. Congestive heart disease
HIV infections/AIDS
Heart disease
Frailty associated with old age—preventing falls and pressure ulcers, maximizing function, and developing advanced care plans
Reduce tobacco use, especially among youth
5. Atherosclerotic disease
5. Pneumonia
Child and adult immunizations
HIV and AIDS
Hypertension—focus on appropriate management of early disease
Reduce the incidence and consequences of injuries and violence
6. Lung disease
Maternal and child health
Immunization—children and adults
7. Atherosclerotic disease
Respiratory diseases
Ischemic heart disease—prevention, reduction of recurring events, and optimization of functional capacity
8. Diabetes mellitus
Nursing home and home health care
Major depression—screening and treatment
9. Hypertension
Patient safety
Medication management—preventing medication errors and overuse of antibiotics
10. Colon cancer
Timeliness
Nosocomial infections—prevention and surveillance
Patient-centeredness
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)
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