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Future Directions for the National Healthcare Quality and Disparities Reports 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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Future Directions for the National Healthcare Quality and Disparities Reports 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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Future Directions for the National Healthcare Quality and Disparities Reports 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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