the offered national priority areas because the committee’s charge was limited to advising AHRQ, but the committee wants to underscore the importance of such a broader commitment to national priority areas. The committee recognizes that health insurance reform legislation establishes a process and method for setting quality improvement priorities in HHS,1 and it believes that the content of the two NHQR and NHDR should align as closely as possible with whatever priorities are ultimately established.


The Healthcare Research and Quality Act of 1999 called for AHRQ to “submit to Congress an annual report on national trends in the quality of health care provided to the American people,” which became the NHQR, and “a report regarding prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations,”2 which became the NHDR. Thus, the legislation states the basic purpose is to report trends and makes clear that the primary intended audience is the U.S. Congress. AHRQ has expressed interest in increasing the visibility of its products among congressional staff and other policy makers as well as other actors in the fields of quality improvement and disparity reduction (Social & Scientific Systems and UserWorks, 2009). AHRQ has interpreted the legislative guidance to mean that the national healthcare reports should report on where the country stands today on selected performance measures and should look back over time (generally the time period from 1998 to 1999 to the latest date for which data are available) to see how far the nation has come. The Future Directions committee believes it is now time to report on trends and be forward-thinking, not just historical.

Previous IOM guidance viewed the audience for the NHQR and NHDR as reaching beyond Congress, and envisioned the reports as vehicles for “educating the public, the media, and other audiences about the importance of health care quality and the current level of quality” (IOM, 2001b, p. 31). Moreover, AHRQ has indicated that today, five main types of users tend to consult the national healthcare reports’ family of print and online products: (1) federal policy makers and congressional staff; (2) associations of state and local agencies and state-based users (e.g., state and local policy makers, Medicaid medical directors, health commissioners, data providers); (3) federal researchers (e.g., researchers at the National Institutes of Health, the HHS Office of Minority Health staff); (4) private sector quality improvement researchers (e.g., researchers at organizations such as The Commonwealth Fund or Kaiser Family Foundation, health care providers, insurers, quality improvement organizations); and (5) advocacy groups (e.g., groups representing priority populations, persons having specific diseases, and professional groups) (Social & Scientific Systems and UserWorks, 2009). The Future Directions committee also believes these audiences need to be aware not only of the current state of system performance, but also what the potential impact of improvement is on the health of the nation and what each action can contribute to its achievement.

Overview of Products and Recommended Changes

Although there is little comprehensive evidence on how users take the information in the NHQR and NHDR and put it into action, there is some limited information on the number of copies ordered and the degree of internet traffic, which at a minimum suggest the products are consulted and quoted to document specific quality problems and disparities. Besides the annual print and Web-based versions of the NHQR and NHDR, report-related products developed by AHRQ include annual State Snapshots (which rate each state’s performance overall and on selected measures relative to other states), an online data query system called the NHQRDRnet, and a limited number of topical fact sheets.

The Future Directions committee finds the print and Web versions of the NHQR and NHDR and their associated online resources are solid compendia of data about the quality of health care and related disparities in the United States. Their strengths have been in their use of “measures and datasets that meet rigorous scientific standards” (IOM, 2002a, p. 6) and promotion of a common understanding of the domains of quality. Nevertheless,


Patient Protection and Affordable Care Act, Public Law 111-148 § 399HH, 111th Cong., 2d sess. (March 23, 2010).


Health Research and Quality Act of 1999, Public Law 106-129 § 902 and § 913, 106th Cong., 1st sess. (December 6, 1999).

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