Future Directions for the National Healthcare Quality and Disparities Reports (2010)

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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 gen- eral 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 Acad- emies 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. 171 

172 NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORTS NVSS, 2005 SIPP, 2001 NHIS, 1996 MEPS, 2005 HCUP, 2005 Causes of activity Most costly Leading causes of death Main causes of disability limitation conditions Hospital principal diagnoses 1. Diseases of the heart 1. Arthritis or 1. Heart disease 1. Heart 1. Newborn infant rheumatism conditions 2. Malignant neoplasms 2. Back or spine problem 2. Back problems 2. Trauma 2. Hardening of the heart arteries (coronary atherosclerosis) 3. Cerebrovascular 3. Heart trouble / 3. Arthritis 3. Cancer 3. Pneumonia diseases hardening of the arteries 4. Chronic lower 4. Lung or respiratory 4. Asthma 4. Mental 4. Congestive heart failure respiratory diseases problem disorders 5. Accidents 5. Deafness or hearing 5. Diabetes 5. Pulmonary 5. Chest pain (unintentional injuries) problem conditions 6. Diabetes mellitus 6. Limb / extremity 6. Mental disorders 6. Trauma to vulva (external female stiffness genitals) and perineum (area between anus and vagina) due to childbirth 7. Influenza and 7. Mental or emotional 7. Disorders of the eye 7. Heart attack (acute myocardial pneumonia problem infarction) 8. Alzheimer’s disease 8. Diabetes 8. Learning disabilities 8. Cardiac dysrhythmias (irregular heart and mental retardation beat) 9. Nephritis, nephritic 9. Blindness or vision 9. Cancer 9. Other maternal complications of birth syndrome, and nephrosis problem and puerperium (period after childbirth) 10. Septicemia 10. Stroke 10. Visual impairments 11. Intentional self-harm 11. Broken bone/ (suicide) fracture 12. Chronic liver disease 12. Mental retardation and cirrhosis 13. Essential (primary) 13. Cancer hypertension and hypertensive renal disease 14. Parkinson’s disease 14. High blood pressure 15. Pneumonitis due to 15. Head or spinal cord solids and liquids 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. 

APPENDIX E 173 IOM, 2003 HHS, 2004 NHIS, 2002 NHIS, 2002 NHIS, 2002 NHQR/NHDR 2005 Black-White Educational Serious racial Interagency Priority areas for quality Major threats to the health disparity in life disparity in life and ethnic Workgroup improvement and well-being of Americans years lost years lost disparities Consensus Cancer screening that is Reduce behavioral and other 1. Hypertension 1. Ischemic heart Infant Cancer evidence based—focus factors that contribute to disease mortality on colorectal and cervical the development of chronic cancer diseases Children with special health Reduce the incidence of 2. HIV 2. Lung cancer Breast and Diabetes care needs sexually transmitted diseases cervical cancer and unintended pregnancies Diabetes—focus on Increase immunization rates 3. Diabetes 3. Cerebrovascular Diabetes End-stage renal appropriate management of among adults and children mellitus disease disease early disease End of life with advanced Reduce substance abuse 4. Homicide 4. Congestive HIV Heart disease organ system failure—focus heart disease infections/ on congestive heart failure AIDS and chronic obstructive pulmonary disease Frailty associated with old Reduce tobacco use, 5. Atherosclerotic 5. Pneumonia Child HIV and AIDS age—preventing falls and especially among youth disease and adult pressure ulcers, maximizing immunizations function, and developing advanced care plans Hypertension—focus on Reduce the incidence and 6. Lung disease Maternal and child appropriate management of consequences of injuries and health early disease violence Immunization—children 7. Atherosclerotic Respiratory diseases and adults disease Ischemic heart disease— 8. Diabetes Nursing home and prevention, reduction mellitus home health care of recurring events, and optimization of functional capacity Major depression— 9. Hypertension Patient safety screening and treatment Medication management— 10. Colon cancer Timeliness preventing medication errors and overuse of antibiotics Nosocomial infections— Patient-centeredness prevention and surveillance 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)