As the United States devotes extensive resources to health care, evaluating how successfully the U.S. system delivers high-quality, high-value care in an equitable manner is essential. At the request of Congress, the Agency for Healthcare Research and Quality (AHRQ) annually produces the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). The reports have revealed areas in which health care performance has improved over time, but they also have identified major shortcomings. After five years of producing the NHQR and NHDR, AHRQ asked the IOM for guidance on how to improve the next generation of reports.

The IOM concludes that the NHQR and NHDR can be improved in ways that would make them more influential in promoting change in the health care system. In addition to being sources of data on past trends, the national healthcare reports can provide more detailed insights into current performance, establish the value of closing gaps in quality and equity, and project the time required to bridge those gaps at the current pace of improvement.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON FUTURE DIRECTIONS FOR THE NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORTS
• Reviewers
• Foreword
• Preface
• Acknowledgments
• Summary
• 1. Introduction
  • STUDY CHARGE AND APPROACH
  • NATIONAL REPORTING ON THE STATE OF QUALITY AND DISPARITIES
  • KEY ISSUES ADDRESSED BY THE COMMITTEE
  • LIMITATIONS OF THE STUDY
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Re-Envisioning the NHQR and NHDR
  • PURPOSE AND AUDIENCES
  • CALLS FOR NATIONAL PRIORITY AREAS
  • THE COMMITTEE’S RECOMMENDED PRIORITY AREAS
  • FOCUSING RESOURCES AND ATTENTION ON NATIONAL PRIORITY AREAS
  • SUMMARY
  • REFERENCES
• 3. Updating the Framework for the NHQR and NHDR
  • THE ORIGINAL FRAMEWORK FOR THE NHQR AND NHDR
  • AN UPDATED FRAMEWORK FOR THE NHQR AND NHDR
  • RATIONALE FOR THE DIMENSIONS OF EQUITY AND VALUE
  • RATIONALE FOR THE FOUR NEW QUALITY OF CARE COMPONENTS
  • SUMMARY
  • REFERENCES
• 4. Adopting a More Quantitative and Transparent Measure Selection Process
  • AHRQ’S APPROACH TO SELECTING MEASURES
  • IMPROVING MEASURE SELECTION
  • PRINCIPLES AND CRITERIA FOR SELECTION
  • QUANTITATIVE TOOLS FOR PRIORITIZING MEASURES
  • SUMMARY
  • REFERENCES
• 5. Enhancing Data Resources
  • BUILDING A NATIONAL DATA INFRASTRUCTURE
  • FILLING MEASUREMENT AND DATA NEEDS
  • IMPROVING RACE, ETHNICITY, LANGUAGE NEED, SOCIOECONOMIC, AND INSURANCE STATUS DATA
  • SUMMARY
  • REFERENCES
• 6. Improving Presentation of Information
  • MATCHING PRODUCTS TO AUDIENCE NEEDS
  • TELLING A STORY IN THE NHQR AND NHDR
  • USING BENCHMARKS TO SHOW ACHIEVEMENT
  • REFINING THE PRESENTATION OF DATA
  • SUMMARY
  • REFERENCES
• 7. Implementing Recommended Changes
  • RESOURCES REQUIRED TO IMPLEMENT RECOMMENDATIONS
  • EVALUATION OF THE AHRQ REPORT-RELATED ENDEAVOR
  • TIMELINE FOR IMPLEMENTING RECOMMENDATIONS
  • CONCLUSION
  • REFERENCES
• Acronyms
• Appendix A Previous IOM Recommendations for the National Healthcare Reports
• Appendix B Key Findings of the NHQRs and NHDRs
• Appendix C Previous Conceptual Framework
• Appendix D Measurement Opportunities for the Framework’s Components of Quality Care
• Appendix E HHS Interagency Workgroup for the NHQR and NHDR
• Appendix F The Expected Population Value of Quality Indicator Reporting (EPV-QIR): A Framework for Prioritizing Healthcare Performance Measurement
• Appendix G IOM Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement: Recommendations
• Appendix H Additional Assessments of Data Presentation in the NHQR and NHDR
• Appendix I An Illustrative Funding Example
• Appendix J Committee Member and Staff Biographies

This study was supported by Task No. #HHSP233200800005T between the National Academy of Sciences and the Agency for Healthcare Research and Quality. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2010. Future Directions for the National Healthcare Quality and Disparities Reports. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.