Future Directions for the National Healthcare Quality and Disparities Reports (2010) / Chapter Skim
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3 Updating the Framework for the NHQR and NHDR
3 Updating the Framework for the NHQR and NHDR
Pages 39-58
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From page 39... ...
Because the framework components accommodate a broad spectrum of measures, and the universe of potential measures is voluminous and ever expanding, the priority areas discussed in the previous chapter are one element in helping define a narrower set of measures within the framework components. (Chapter 4 includes the Future Directions committee's recommendations on further defining the set of measures according to their potential health care quality impact.)
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From page 40... ...
The framework remains applicable to both the NHQR and NHDR. The Future Directions committee looked to prominent organizations and collaboratives engaged in health care quality improvement and disparities elimination for their informed perspectives on the latest advancements in and concerns about the current state of health care.
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From page 41... ...
The Future Directions committee identified care coordination and capabilities of health systems infrastructure as necessary health care components to include in the national healthcare reports. These components are not necessarily health care aims/attributes in themselves, but are a means to those aims since they are elements of the health care system that better enable the provision of quality care.
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From page 42... ...
Application of the Care Components As noted in Envisioning the National Healthcare Quality Report, "The framework is a tool for organizing the way one thinks about health care quality. It provides a foundation for quality measurement, data collection, and subsequent reporting" (IOM, 2001b, p.
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From page 43... ...
Additional justification for including equity and value, as well as each of the added quality of care components, is discussed in the following sections. To complement the justifications, Appendix D explores measurement possibilities for access, efficiency, care coordination, and health systems infrastructure.
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From page 44... ...
. Guidance for the National Healthcare Disparities Report reiterated that AHRQ should use the framework recommended in Envisioning the National Healthcare Quality Report as the basis for the NHDR and that the NHDR was to "highlight health care issues related to equity and the extent to which health care disparities undermine its achievement" (IOM, 2002)
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From page 45... ...
. The Future Directions committee presents value as a crosscutting dimension of health care quality such that a high-value health care system is one that maximizes all the components of quality care outlined in the proposed
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From page 46... ...
This chapter does not present the rationale for including the pre-existing framework components of effectiveness, safety, timeliness, and patient centeredness as the rationale for each was presented in Envisioning the National Healthcare Quality Report, and AHRQ has responded by reporting on these topics. Access The IOM defines access as "the timely use of personal health services to achieve the best possible health outcomes" (IOM, 1993, p.
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From page 47... ...
Efficiency was previously omitted from the original framework recommended in Envisioning the National Healthcare Quality Report on the grounds that it was "outside the scope of the Quality Report and will be better addressed by specific efforts designed to face the considerable methodological and measurement challenges This committee has been informed by AHRQ staff that the 2009 NHQR will include data on insurance and underinsurance status.
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From page 48... ...
. Examples show that some of the most cost-efficient delivery of health care services is occurring in settings with the highest quality care, providing models for others of how to attain efficient and high-quality care that offers high value (Cantor et al., 2007; The Commonwealth Fund Commission on a High Performance Health System, 2008)
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From page 49... ...
. Other organizations, including CMS, WHO, The Commonwealth Fund, NQF, and the NPP, have also identified care coordination as a valuable component for enhancing health care delivery and patient experiences (CMS, 2008b; The Commonwealth Fund Commission on a High Performance Health System, 2006; NPP, 2008; NQF, 2009; WHO, 2008)
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From page 50... ...
Additional suggestions for reporting care coordination measures can be found in Appendix D Capabilities of Health Systems Infrastructure Ensuring well-coordinated, high-quality health care requires supportive systems infrastructure.
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From page 51... ...
HIT Infrastructure As the future of health care becomes more electronically driven, adequate HIT systems will increasingly provide a foundation for tracking quality improvement in care delivery and patient outcomes. Although the adoption of an HIT system is no guarantee of better health care quality outcomes, and more work is needed to determine its impact on quality improvement, the increased and more efficient use of HIT can make available additional sources of valuable data on clinical outcomes (Arrow et al., 2009)
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From page 52... ...
Furthermore, analyzing these data in conjunction with information on receipt of health care services and patient outcomes would be the type of informative analyses that the Future Directions committee would like to see provided in the NHQR and NHDR. AHRQ could provide other assessments of availability for various types of health care professionals to better inform this issue, including but not limited to information on primary care and specialist physicians, nurses, mental health, and dental care professionals.
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From page 53... ...
SUMMARY The framework proposed by this committee can be viewed as a building block for AHRQ's national healthcare reports, as it provides a foundation on which to base the reporting of national health care performance. The additional quality components of access, efficiency, care coordination, and health systems infrastructure capabilities should be viewed as areas in which evidence has shown potential for improving quality care, and progress should be made in how to measure the impact of these components on the delivery system.
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From page 54... ...
2006. Reducing racial and ethnic disparities in health care: An integral part of quality improvement scholarship.
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From page 55... ...
2008. Losing ground: How the loss of adequate health insurance is burdening working families -- findings from The Commonwealth Fund biennial health insurance surveys, 2001–2007.
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From page 56... ...
2009. Hudson River HealthCare quality improvement plan 2009.
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From page 57... ...
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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From page 58... ...
2009c. Table 8: People without health insurance coverage by race and Hispanic origin using 2- and 3-year averages: 2005-2006 and 2007-2008, in Income, Poverty, and Health Insurance Coverage in the United States: 2008.
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