Future Directions for the National Healthcare Quality and Disparities Reports (2010) / Chapter Skim
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5 Enhancing Data Resources
5 Enhancing Data Resources
Pages 89-110
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From page 89... ...
At the same time, there is extensive development and testing of new measures to fill shortcomings in measurement areas or improve existing measures. The Future Directions committee believes AHRQ, by leveraging its position as the producer of the NHQR and NHDR can identify health care quality measurement and data needs for development, and utilize subnational data sources when national data do not yet exist.
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From page 90... ...
The American Recovery and Reinvestment Act of 2009 authorizes and provides resources for the Office of the National Coordinator for Health Information Technology (ONC) within HHS to guide the "development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information." Proposed rules on standards to receive Medicare and Medicaid reimbursement incentives for the implementation of EHRs were issued in December 2009 and describe ways in which EHR systems should be used for purposes that include quality improvement and the elimination of disparities in health and health care (CMS, 2010)
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From page 91... ...
The Northern New England Cardiovascular Disease Study Group, National Surgical Quality Improvement Program, and National Quality Program of the Cystic Fibrosis Foundation are examples of registries with an explicit focus on provider specific performance, sharing data, exploring the causes of variations in outcomes, and applying established quality improvement techniques (e.g., benchmarking and site visits to high-performing providers) (American College of Surgeons, 2009; Cystic Fibrosis Foundation, 2009; Leavitt et al., 2009; Likosky et al., 2006)
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From page 92... ...
Incorporating information from additional data sources into the NHQR and NHDR could help to ensure that the reports tell a more complete story of the nation's progress in improving the quality of health care. These additional data sources may be nationally representative or national in scope (e.g., the National Surgical Quality Improvement Program, the Cystic Fibrosis Patient Registry)
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From page 93... ...
. The committee believes that looking "under the lamppost" and potentially missing important areas of quality measurement is an apt metaphor of caution for the selection of national measures for inclusion in the NHQR, NHDR, and related products. If the reports measure only areas for which national data are currently available, the measure selection process becomes circular, precluding development of new measures in national priority areas for health care quality improvement.
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From page 94... ...
Using subnational data could not only fill gaps where important national measures do not currently exist, but also could spur development of nationally representative data for measurement areas. Criteria for the Use of Subnational Data As the previous discussion indicates, subnational datasets have the potential -- in both the interim and longterm -- to supplement information presented in the NHQR and NHDR.
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From page 95... ...
. Regional quality improvement initiatives such as Minnesota Community Measurement, the Integrated Healthcare Association, and the Wisconsin Collaborative for Healthcare Quality measure HIT use within their respective states (Minnesota, California, and Wisconsin, respectively)
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From page 96... ...
Then, it evaluates the variables by which AHRQ stratifies data, the data sources used to create the NHDR, and the ways in which AHRQ analyzes disparities data. Enhanced Collection, Analysis, and Reporting In 2008, AHRQ contracted with the IOM to form the Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement in conjunction with the Committee on Future Directions for the National Healthcare Quality and Disparities Reports.
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From page 97... ...
. The subcommittee recommended, and the committee concurs, that health care-related entities should collect data on granular ethnicity -- defined as "a person's ethnic origin The full text of Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement is available at http://www.nap.
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From page 98... ...
• American Indian or • "Other, please Alaska Native specify:___" response • Native Hawaiian or Other option Pacific Islander • Rollup to the OMB • Some other race categories Spoken English Language Spoken Language Preferred Proficiency for Health Care • Very well • Locally relevant choices from a Language Need • Well national standard list of • Not well approximately 600 categories • Not at all with coding to be determined* • "Other, please specify:__" (Limited English proficiency is response option defined as "less than very well")
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From page 99... ...
The Rationale for Socioeconomic Data Examining socioeconomic status (SES) and insurance status was outside the scope of the subcommittee's task, although the subcommittee acknowledged the importance of these factors when assessing health care quality.
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From page 100... ...
The Rationale for Insurance Status Data A 2009 IOM report on the consequences of uninsurance concluded that "health insurance is integral to personal well-being and health" (IOM, 2009a, p.
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From page 101... ...
The subcommittee report Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement recommended actions to improve data processes across the health care system. These recommendations, with which the Future Directions committee agrees, are as follows: • The necessary variables for disparities measurement (i.e., race, Hispanic ethnicity, granular ethnicity, Eng lish language proficiency, and preferred spoken language)
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From page 102... ...
has updated its SS-5 form (to include all of the OMB race and Hispanic ethnicity categories) (Social Security Administration, 2009)
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From page 103... ...
The NQF has noted that addressing issues of quality within "vulnerable patient populations" requires stratifying measures by "gender, race, ethnicity, SES, primary language, and insurance status." This chapter's discussion of the rationale for race, ethnicity, language need, SES, and insurance status data highlights the importance of exploring quality measures by these variables. Analyzing these measures within the context of social determinants of health (e.g., neighborhood environments)
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From page 104... ...
. The committee commends AHRQ for indicating where reliable data are and are not available and encourages AHRQ to expand its table of data availability to include not only all of the OMB race and Hispanic ethnicity categories, but also availability of granular ethnicity, language need, SES, and insurance status data.
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From page 105... ...
Figure 5-2 from original the NHDR and derivative products source to include quality measures stratified by more granular ethnicity groups within the OMB categories whenever the data are available. replaces blurry low-resolution bitmap image • Document shortcomings in the availability of OMB-level race and Hispanic ethnicity data, granular ethnicity data, language need, and socioeconomic and insurance status data to sup port these analyses; work to enhance the collection of these data in future iterations of the source datasets; and whenever necessary, should utilize alternative valid and reliable data sources to provide needed information even if it is not available nationally.
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From page 106... ...
2008. Health care coverage analyses of the 2006 National Healthcare Quality and Disparities Reports.
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From page 107... ...
2001. Envisioning the National Healthcare Quality Report.
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From page 108... ...
National Center for Health Statistics. Pre sentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, February 9, 2009.
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From page 109... ...
Quality Alliance Steering Committee. Pre sentation to the IOM Committee on Future Directions for the National Healthcare Quality and Disparities Reports, February 10, 2009.
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From page 110... ...
: S150-S157. Wisconsin Collaborative for Healthcare Quality.
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