Preliminary Measure Set, National Healthcare Quality Report


Congress has given the Agency for Healthcare Research and Quality (AHRQ) a mandate to report annually to the Nation about health care quality. An interagency workgroup developed a preliminary set of quality measures for the report (below), and AHRQ seeks comments on the measures.

Select for Background on the preliminary measures and the Update on the National Healthcare Quality Report.


Contents

Effectiveness of Care
   Cancer / Chronic kidney disease / Diabetes / Heart disease / HIV/AIDS / Maternal and child health /
   Mental health / Respiratory diseases / Long-term care
Safety
Timeliness
Patient Centeredness of Care
Resource Consumption
Overall Measures

Effectiveness of Care

  Measure National
Data Basea
State
Data Basea
Consensus
Processb
Cancer: Screening for breast cancer Process: % of women (age 40 and over, 50-69) who report they had a mammogram within the past 2 years NHIS BRFSS NCQA, HP2010, AMA
Outcome: % of breast cancers diagnosed at late stage SEER    
Cancer: Screening for cervical cancer Process: % of women (18 and over) who report that they had a Pap smear within the past 3 years NHIS BRFSS NCQA, HP2010
Outcome: % of cervical cancers diagnosed at late stage SEER    
Cancer: Screening for colorectal cancer Process: % of men and women (50 and older) who report they ever had a flexible sigmoidoscopy/colonoscopy NHIS BRFSS HP2010
Process: % of men and women (50 and over) who report they had a fecal occult blood test (FOBT) within the past 2 years NHIS BRFSS HP2010
Outcome: % of colorectal cancers diagnosed at late stage SEER    
Cancer: Cancer treatment Outcome: Cancer deaths per 100,000 persons per year for all cancers Vital statistics Vital statistics HP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, prostate cancer Vital statistics Vital statistics HP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, breast cancer Vital statistics Vital statistics HP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, lung cancer Vital statistics Vital statistics HP2010
Outcome: Cancer deaths per 100,000 persons per year for most common cancers, colorectal cancer Vital statistics Vital statistics HP2010
Cancer: Palliative care Process: % of people who died of cancer who received hospice care NHHCS    
Process: Average length of stay for cancer patients who received hospice care (reflects delayed referrals) NHHCS    
Process: % of cancer patients receiving hospice care in the home who were transferred to inpatient care (ability to maintain pt. at home) NHHCS    
Chronic kidney disease: Management of end-stage renal disease (ESRD) Number of patients on waiting list for kidney transplant and number of transplants USRDS USRDS  
Outcome: Average urea reduction ratio USRDS USRDS CMS
Outcome: Average hematocrit USRDS USRDS CMS
Outcome: First year patient death rates, by treatment modality USRDS USRDS CMS
Diabetes: Management of diabetes Process: % of people with diabetes with condition diagnosed NHANES   HP2010
Process: % of adults with diabetes who had a hemoglobin A1c measurement at least once in past year MEPS BRFSS AMA/JCAHO/
NCQA,
HP2010
Process: % of patients with diabetes who had a lipid profile in past two years MEPS   AMA/JCAHO/
NCQA
Process: % of adults with diabetes who had a retinal eye examination in past year MEPS BRFSS AMA/JCAHO/
NCQA,
HP2010
Process: % of adults with diabetes who had a foot examination in past year MEPS BRFSS AMA/JCAHO/
NCQA,
HP2010
Process: % of adults with diabetes who had an influenza immunization in past year MEPS BRFSS AMA/JCAHO/
NCQA
Outcome: % of adults with diabetes with HbA1c level under control NHANES   AMA/JCAHO/
NCQA
Outcome: % of adults with diabetes with lipid level under control NHANES   AMA/JCAHO/
NCQA
Outcome: % of adults with diabetes with blood pressure under control NHANES   AMA/JCAHO/
NCQA
Outcome: Hospital admissions for uncontrolled diabetes per 100,000 population HCUP HCUP HP2010,
HCUP-QI
Outcome: Hospital admissions for short term complications of diabetes per 100,000 population HCUP HCUP HCUP-QI
Outcome: Hospital admissions for long term complications of diabetes per 100,000 population HCUP HCUP HCUP-QI
Outcome: Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 population NHDS, HCUP HCUP HP2010,
HCUP-QI
Heart disease: Screening for high blood pressure Process: % of people age 21 and over having blood pressure checked within past 2 years NHIS BRFSS  
Heart disease: Screening for high cholesterol Process: % of men (age 35-65) and women (age 45-65) receiving cholesterol measurement within past 5 years NHIS BRFSS HP2010
Heart disease: Counseling on risk factors Process: % of smokers receiving advice to quit smoking MEPS BRFSS NCQA, HP2010, AMA
Heart disease: Treatment of acute myocardial infarction (AMI) Process: % of AMI patients administered aspirin within 24 hours of admission Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NCQA,
NQF(draft)
Process: % of AMI patients with aspirin prescribed at discharge Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients administered beta blocker within 24 hours of admission Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients with beta blocker prescribed at discharge Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of AMI patients given smoking cessation counseling while hospitalized Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: Median time from admission to reperfusion for AMI patients with ST segment elevation or left bundle branch block Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Outcome: AMI mortality (within 30 days of admission) Medicare claims Medicare claims ~JCAHO,
NQF(draft)
Heart disease: Treatment of acute heart failure Process: % of heart failure patients having evaluation of left ventricular ejection fraction Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Outcome: Mortality after acute heart failure (within 30 days of admission) Medicare claims Medicare claims ~JCAHO,
NQF(draft)
Heart disease: Management of hypertension Outcome: % of people with hypertension who have blood pressure under control NHANES   NCQA, HP2010
Heart disease: Management of congestive heart failure (CHF) Outcome: Hospital admissions for congestive heart failure (CHF) per 100,000 population NHDS, HCUP HCUP HP2010,
HCUP-QI
HIV/AIDS: AIDS prevention Outcome: New AIDS cases per 100,000 population (age 13 and over) HIV/AIDS
surveillance
system
HIV/AIDS
surveillance
system
HP2010
HIV/AIDS: Management of HIV/AIDS Process: % of HIV-infected persons receiving highly active antiretroviral therapy (HAART) Adult Spectrum of Disease Survey   HP2010
Outcome: HIV-infection deaths per 100,000 population Vital statistics Vital statistics HP2010
HIV/AIDS: Palliative care Process: % of people who died of AIDS who received hospice care NHHCS    
Process: Average length of stay for AIDS patients who received hospice care (reflects delayed referrals) NHHCS    
Process: % of AIDS patients receiving hospice care in the home who were transferred to inpatient care (ability to maintain patient at home) NHHCS    
Maternal and child health: Maternity care Process: % of pregnant women receiving prenatal care in first trimester Vital Statistics Vital Statistics HP2010, LHI
Outcome: % of liveborn infants with low and very low birthweight (less than 2,500 grams, less than 1,500 grams) Vital Statistics Vital Statistics HP2010
Outcome: Infant mortality per 1,000 live births, by birth weight Vital Statistics Vital Statistics HP2010, JCAHO
Outcome: Maternal deaths per 100,000 live births Vital Statistics Vital Statistics HP2010
[See Safety measures for complications of obstetric care]      
Maternal and child health: Childhood immunizations Process: % of children 19-35 months who received all recommended vaccines NIS NIS NCQA, HP2010,
LHI
Process: % of children 19-35 months who received 4 doses of DPaT vaccine NIS NIS NCQA, HP2010
Process: % of children 19-35 months who received 3 doses of polio vaccine NIS NIS NCQA, HP2010
Process: % of children 19-35 months who received 1 dose of MMR vaccine NIS NIS NCQA, HP2010
Process: % of children 19-35 months who received 3 doses of Hib vaccine NIS NIS NCQA, HP2010
Process: % of children 19-35 months who received 3 doses of hepatitis B vaccine NIS NIS NCQA, HP2010
Process: % of children 19-35 months who received 1 dose of varicella vaccine NIS NIS NCQA, HP2010
Maternal and child health: Adolescent immunizations Process: % of adolescents (age 13-15) reported to have received 3 or more doses of hepatitis B vaccine NHIS   HP2010
Process: % of adolescents (age 13-15) reported to have received 2 or more doses of MMR vaccine NHIS   HP2010
Process: % of adolescents (age 13-15) reported to have received 1 or more doses of tetanus-diphtheria booster NHIS   HP2010
Process: % of adolescents (age 13-15) reported to have received 3 or more doses of varicella vaccine NHIS   HP2010
Maternal and child health: Childhood dental care Process: Time since last dental contact (1 year or less, more than 1 year but not more than 3 years, more than 3 years) NHIS    
Outcome: % of children with untreated dental decay NHANES   HP2010
Maternal and child health: Treatment of pediatric gastroenteritis Outcome: Hospital admissions for pediatric gastroenteritis per 100,000 population less than 18 years of age HCUP HCUP HCUP-QI
Mental health: Treatment of depression Process: % of adults with depression who received treatment NHSDA NHSDA HP2010, LHI
Process: % of adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase HEDIS   NCQA
Process: % of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase HEDIS   NCQA
Process: % of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment HEDIS   NCQA
Outcome: Deaths due to suicide per 100,000 population Vital Statistics Vital Statistics HP2010
Respiratory diseases: Influenza immunization Process: % of high risk persons (e.g. COPD) age 18-64 who received an influenza vaccination in the past 12 months NHIS BRFSS HP2010
Process: % of persons age 65 and over who received an influenza vaccination in the past 12 months NHIS BRFSS NCQA, HP2010,
LHI
Process: % of institutionalized adults (persons in long-term care or nursing homes) who received influenza vaccination in past 12 months NNHS   HP2010
Outcome: Hospital admissions for immunization-preventable influenza per 100,000 population HCUP HCUP HP2010
Respiratory diseases: Pneumococcol immunization Process: % of high risk persons (e.g. COPD) age 18-64 who ever received an pneumococcol vaccination NHIS BRFSS HP2010
Process: % of persons age 65 and over who ever received an pneumococcol vaccination NHIS BRFSS NCQA, AMA,
HP2010, LHI
Process: % of institutionalized adults (persons in long-term care or nursing homes) who ever received pneumococcol vaccination NNHS   HP2010
Outcome: Hospital admissions for immunization-preventable pneumonia per 100,000 population HCUP HCUP HP2010
Respiratory diseases: Treatment of pneumonia Process: % of patients with pneumonia who have blood cultures collected before antibiotics are administered Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive the initial antibiotic dose within 8 hours of hospital arrival Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive the initial antibiotic consistent with current recommendations Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive influenza screening or vaccination Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Process: % of patients with pneumonia who receive pneumococcal screening or vaccination Medicare PRO
chart review
Medicare PRO
chart review
JCAHO,
NQF(draft)
Outcome: Pneumonia mortality (within 30 days of admission)      
Respiratory diseases: Treatment of upper respiratory infection (URI) Process: % of visits where antibiotic prescribed for sole diagnosis of a common cold, children NAMCS/
NHAMCS
  ~HP2010
Process: % of visits where antibiotic prescribed for sole diagnosis of a common cold, adults NAMCS/
NHAMCS
  ~HP2010
Respiratory diseases: Management of asthma Process: % of people with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma (inhaled corticosteroids) HEDIS   AMA, NCQA
Outcome: Hospital admissions for pediatric asthma per 100,000 population under age 18 NHDS, HCUP HCUP HP2010,
HCUP-QI
Outcome: Hospital admissions for adult asthma per 100,000 population age 18-64 NHDS, HCUP HCUP HP2010,
HCUP-QI
Long-term care: Nursing facility care Chronic care: Weight loss prevalence MDS MDS CMS
Chronic care: Inadequate pain management MDS MDS CMS
Chronic care: Late-loss ADL worsening MDS MDS CMS
Chronic care: Infections prevalence MDS MDS CMS
Chronic care: Stage 1-4 pressure ulcer prevalence MDS MDS CMS
Chronic care: Restraint use prevalence MDS MDS CMS
Post acute care: Failure to improve/manage delirium symptoms MDS MDS CMS
Post acute care: Inadequate pain management MDS MDS CMS
Post acute care: Improvement in walking MDS MDS CMS
Long-term care: Home health care To be determined (plan is to include measures from CMS's public reporting initiative, which is currently under development).      

Safety

  Measure National
Data Basea
State
Data Basea
Consensus
Processb
Complications of care Selected postoperative complications (composite) HCUP HCUP HCUP-QI
Selected technical adverse events (composite) HCUP HCUP HCUP-QI
Technical difficulty with selected procedures (composite) HCUP HCUP HCUP-QI
Obstetric trauma (composite) HCUP HCUP HCUP-QI
Birth trauma HCUP HCUP HCUP-QI
Death in low mortality DRG HCUP HCUP HCUP-QI
Failure to rescue HCUP HCUP HCUP-QI
Transfusion reaction HCUP HCUP HCUP-QI
Foreign body left in body during procedure HCUP HCUP HCUP-QI
Central line-associated bloodstream infection in ICU patients NNIS   HP2010
Central line-associated bloodstream infection in infants weighing 1000 grams or less at birth in intensive care NNIS   HP2010
Prescribing medications % of elderly who received potentially inappropriate medications MEPS    
% of patients who report that usual source of care asks about Rx from other providers MEPS    
Injuries in nursing facilities Falls MDS MDS  
Fractures MDS MDS  

Timeliness

  Measure National
Data Basea
State
Data Basea
Consensus
Processb
Basic access % of persons who report that they have a usual source of medical care, by place of care NHIS   HP2010
% of families that experience difficulties in obtaining care, by reason MEPS   HP2010
Getting appointments % of persons who report that they can get an appointment for routine care as soon as they wanted (always, usually, sometimes/never) MEPS NCBD  
% of persons who report that they can get care for illness/injury as soon as they wanted (always, usually, sometimes/never) MEPS NCBD  
Waiting time ED visits: Average time from arrival to being seen by a physician (separately for emergent, urgent, semi-urgent, and non-urgent visits) NAMCS/
NHAMCS
   
ED visits: % of patients who left without being seen NAMCS/
NHAMCS
   
OP/clinic visits: Average time spent waiting before being seen by doctor MEPS    
Office visits: Average time spent waiting before being seen by doctor MEPS    

Patient Centeredness

  Measure National
Data Basea
State
Data Basea
Consensus
Processb
Patient experience of care % of patients who report that doctor listens carefully (always, usually, sometimes/never), adults and parents of children MEPS NCBD  
% of patients who report that doctor explains things clearly (always, usually, sometimes/never), adults and parents of children MEPS NCBD  
% of patients who report that doctor showed respect for what you had to say (always, usually, sometimes/never), adults and parents MEPS NCBD  
% of patients who report that doctor spent enough time with them (always, usually, sometimes/never), adults and parents of children MEPS NCBD  

Resource Consumption

Measure National
Data Basea
State
Data Basea
Consensus
Processb
Total national health expenditures by expenditure type and source of funds NHA    
Per capita health expenditures by source of funds and state NHA NHA  
% of GDP spent on health - US and OECD countries WHO    
% of gross state product spent on health   NHA  

Overall Measures

Measure National
Data Basea
State
Data Basea
Consensus
Processb
Overall rating of health care received MEPS NCBD  
Life expectancy (at birth, at age 65) Vital statistics    
Days of activity limitation due to health NHIS BRFSS  

a BRFSS=Behavioral Risk Factor Surveillance System;
HCUP=Healthcare Cost and Utilization Project;
HEDIS=Health Plan and Employer Data Information Set;
MEPS=Medical Expenditure Panel Survey;
MDS=Minimum Data Set;
NAMCS=National Ambulatory Medical Care Survey;
NCBD=National CAHPS Benchmarking Database;
NHA=National Health Accounts;
NHANES=National Health and Nutrition Examination Survey;
NHIS=National Health Interview Survey;
NHHCS=National Home Health and Hospice Care Survey;
NHAMCS=National Hospital Ambulatory Medical Care Survey;
NHDS=National Hospital Discharge Survey;
NIS=National Immunization Survey;
NNHS=National Nursing Home Survey;
Vital statistics=National Vital Statistics System, Mortality;
SEER=Surveillance, Epidemiology, and End Results Program;
USRDS=United States Renal Data System;
WHO=World Health Organization;
~=Approximation of measure from given measure set.

bAMA=American Medical Association Consortium's core physician performance measures set;
AMA/JCAHO/NCQA=Joint statement on performance measures for the management of diabetes;
CMS=Centers for Medicare & Medicaid Services public reporting initiative;
HCUP-QI=Healthcare Cost and Utilization Project quality indicators (prevention, inpatient, and patient safety indicators);
HP2010=Healthy People 2010;
JCAHO=Joint Commission for Accreditation of Healthcare Organization's hospital core measures;
LHI=Leading Health Indicators;
NCQA=National Committee for Quality Assurance's HEDIS measure set;
NQF=National Quality Forum hospital quality measures (draft);
~=Approximation of measure from given measure set.

Current as of July 2002


Internet Citation:

Preliminary Measure Set, National Healthcare Quality Report. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhrq02/premeasures.htm


Return to Measuring Healthcare Quality
Quality Assessment
AHRQ Home Page
Department of Health and Human Services