Future Directions for the National Healthcare Quality and Disparities Reports (2010) / Chapter Skim
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2 Re-Envisioning the NHQR and NHDR
2 Re-Envisioning the NHQR and NHDR
Pages 21-38
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From page 21... ...
Progress on this agenda could then be monitored by the national healthcare reports. AHRQ charged the Future Directions committee to assess the national healthcare reports, provide guidance on what the future generation of these reports should embody, and advise on national priority areas for health care quality improvement and disparities elimination.
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From page 22... ...
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.
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From page 23... ...
BOX 2-1 Objectives for AHRQ's Reporting Effort in the NHQR, NHDR, and Related Products The IOM Future Directions committee believes that the NHQR, NHDR, and related products should play a vital role in U.S. health care quality improvement and disparity elimination efforts.
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From page 24... ...
. For example, the Future Directions committee advocates for comparing population groups in the NHDR to a quality benchmark or goal, not just to each other.
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From page 25... ...
To date, the inclusion of such comparative information has been limited, and little analysis has been presented beyond straight reporting on individual measures; some limited stratification and multivariate analyses are included in the NHDR by population but not by entities providing care or paying for it. The Future Directions committee recommends sufficient resources be provided to AHRQ for the data collection and analysis necessary to provide such comparative information (Chapter 7)
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From page 26... ...
CALLS FOR NATIONAL PRIORITY AREAS In past years, the IOM and other entities have called for the establishment of national priority areas and goals for coordinated health care quality improvement efforts. Examples of these calls for national priorities are described below, along with discussion of the limited actions taken by AHRQ with respect to incorporating priority areas into the NHQR and NHDR.
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From page 27... ...
. Similarly, recent health insurance reform bills have called for the formulation of a national strategy for quality improvement, including naming priority areas and a mechanism for choosing them. Despite the many calls for national priorities, HHS has yet to establish national priority areas for health care performance measurement and quality improvement that could help focus the collective efforts across HHS programs and be adopted by other federal agencies and entities engaged in health care quality improvement, including the elimination of disparities. HHS has a strategic planning process in place that sets goals for HHS programs and offers targets for monitoring progress on specific performance indicators.
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From page 28... ...
, the Future Directions committee identifies a set of eight national priority areas for focusing national health care quality improvement efforts and for use in selecting measures for the NHQR and NHDR. Before presenting the committee's recommendations, however, it is important to define and distinguish among the terms aim, priority area, goal, benchmark, and target as they are used by this committee (see Box 2-2)
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From page 29... ...
. Stakeholders include AARP, AFL-CIO, Agency for Healthcare Research and Quality, Aligning Forces for Quality, Alliance for Pediatric Quality, American Board of Medical Specialties, American Health Care Association, American Nurses Association, America's Health Insurance Plans, AQA, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, Certification Commission for Health Information Technology, Consumers Union, Hospital Quality Alliance, Institute for Healthcare Improvement, Institute of Medicine, Johnson & Johnson, The Joint Commission, The Leapfrog Group, National Association of Community Health Centers, National Business Group on Health, National Committee for Quality Assurance, National Governors Association, National Institutes of Health, National Partnership for Woman & Families, National Quality Forum, Pacific Business Group on Health, Physician Consortium for Performance Improvement convened by the American Medical Association, PQA, Quality Alliance Steering Committee, and the U.S.
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From page 30... ...
The committee scanned articulated priority areas for health care quality improvement across a variety of these entities and has summarized them, along with priority areas identified by the previous IOM committees and the NPP, in Table 2-1. The NPP did not limit selection of national priority area goals to areas where proven interventions are available (e.g., obesity is a problem, but there is not a clear-cut intervention strategy)
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From page 31... ...
Until a national set of priority areas is established, AHRQ should be guided by the Future Directions committee's recommended priority areas. While the committee has recommended eight national priority areas that are crosscutting in nature, that does not mean that tracking disease-specific measures of health care quality will no longer be necessary.
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From page 32... ...
Increase patient and Improve patient Confident, informed Patient engagement family engagement experience of care consumers; (quality, access, and transparency reliability) Improve population Improve population Public health Improved population Healthy lives; health (Reducing health promotion and health prevention and disease burden)
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matters disparities in care Access Timely health care (insurance coverage) Cost (per capita More effective care Structure Efficient health care expenditures; payment preventable to improve hospitalizations)
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From page 34... ...
However, focusing the combined efforts of many actors and various intervention techniques on the same priorities could be expected to enhance progress, whether they are the priorities that are recommended in this report or a set that emerges as a result of developing the national quality improvement strategy pursuant to health reform legislation.14 While AHRQ can use the priority areas offered in this report to select measures and guide the content of the NHQR and NHDR, it is not AHRQ's role to set intervention-related policies for a national quality improvement agenda that can have implications for resource allocation across HHS and external sources. Since AHRQ falls under the direction of the Secretary of HHS, the Future Directions committee concludes that HHS leadership is needed to establish national priorities and set clear goals that can be featured in the national healthcare reports and thereby bring to bear the resources of the department.
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From page 35... ...
Under the Patient Protection and Affordable Health Care Act, the President would convene an interagency working group to foster collaboration between departments and agencies with respect to developing and disseminating strategies and goals for national health care quality priorities. The working group would be comprised of representatives from various HHS agencies, the Department of Commerce, the Office of Management and Budget, the Social Security Administration, the Department of Labor, the U.S.
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From page 36... ...
capabilities of health systems infrastructure. While the Future Directions committee believes AHRQ can incorporate the offered priority areas into the NHQR and NHDR, especially through its messaging and measure selection process, more progress will be made toward achieving priority area goals if there is more widespread adoption and integration of national priority areas into a common quality and disparities improvement strategy.
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From page 37... ...
Agency for Healthcare Research and Quality. Presentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, February 9, 2009.
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From page 38... ...
Agency for Healthcare Research and Quality. Presentation to the IOM Com mittee on Future Directions for the National Healthcare Quality and Disparities Reports, February 9, 2009.
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