Background on the Measures Development Process
National Healthcare Disparities Report, 2002
In its reauthorization legislation, Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce an annual report on health care disparities in the United States (Public Law 106-129). The National Healthcare Disparities Report (NHDR) includes a broad set of performance measures that can be used to monitor the Nation's progress toward improved health care quality for all Americans. The following briefly summarizes the original NHDR measures development process.
Because the NHDR and the National Healthcare Quality Report (NHQR) have been designed as companion reports, they use identical measures of health care quality—i.e., indicators of effectiveness, safety, timeliness, and patient centeredness—to the extent possible with available data. In addition to examining disparities in quality of care, the NHDR also examines disparities in access to health care.
Many organizations worked with AHRQ to help develop the measure set, conceptual framework, and products for the first National Healthcare Disparities Report (NHDR). These groups include:
- NHDR Data Group.
- NHDR Interagency Workgroup.
- IOM Committee on Guidance for Designing a National Healthcare Disparities Report.
NHDR Data Group
AHRQ formed the NHDR Data Group, an internal committee comprised of staff with expertise in health care disparities and data analysis. In its weekly meetings, these staff members focused on:
- Defining racial and socioeconomic factors and priority populations.
- Identifying data sources.
- Developing preliminary access, utilization, and cost measures relevant to studying disparities.
NHDR Interagency Workgroup
The NHDR Interagency Workgroup of the Department of Health and Human Services (HHS) includes representatives from:
- Administration on Aging.
- Administration for Children and Families.
- Centers for Disease Control and Prevention.
- Centers for Medicare & Medicaid Services.
- Food and Drug Administration.
- Health Resources and Services Administration.
- Indian Health Service.
- National Institutes of Health.
- Substance Abuse and Mental Health Administration.
- Office of Civil Rights.
- Assistant Secretary for Legislation.
- Assistant Secretary for Planning and Evaluation.
- Assistant Secretary for Public Affairs.
- Assistant Secretary for Health/Principal Deputy Assistant for Health/Deputy Assistant Secretary for Minority Health.
This group, in its monthly meetings, provided invaluable advice and comments on draft definitions and measures and identified new data sources and measures for inclusion in the NHDR.
IOM's Committee on Guidance for Designing a NHDR
AHRQ contracted with the Institute of Medicine (IOM) to provide guidance for the NHDR. The IOM formed the Committee on Guidance for Designing a National Healthcare Disparities Report, which was comprised of 13 leading experts in health care disparities from across the country.
Chaired by Dr. Sheldon Greenfield, the committee commissioned papers, held public meetings, and heard testimony from a wide variety of groups including:
- Association of Academic Health Centers.
- Asian and Pacific Islander American Health Forum.
- Washington Business Group on Health.
- American Association of People with Disabilities.
- Nebraska Center for Rural Health Research.
- American Medical Association.
- National Medical Association.
- Association of State and Territorial Health Officials.
- National Rural Health Association.
The IOM committee's recommendations were published in Guidance for the National Healthcare Disparities Report in September 2002. For more information, go to the IOM's Disparities Web site.
Because high quality care is critical to eliminating health care disparities, the NHDR benefited greatly from the work being done on the National Healthcare Quality Report by AHRQ staff. AHRQ also acknowledges the work conducted by members of NHQR's Interagency Workgroup.
The Interagency Workgroups for both the NHDR and the NHQR continue to provide advice on data and measures development for the reports.
The NHDR is built on the conceptual framework that the IOM developed for AHRQ's congressionally mandated National Healthcare Quality Report. This framework can be visualized as a matrix, relating dimensions of care (e.g., access, utilization, cost, and quality) to patient needs (e.g., staying healthy, getting better, living with illness or disability, coping with the end of life).
Select for Conceptual Framework (66 KB).
Comments on Measures for the First NHDR
In addition to the NHQR measures, AHRQ staff explored data and measures from a wide variety of sources. AHRQ also reviewed and accepted suggestions for possible databases and specific measures that were submitted by the public in response to a Federal Register notice published on June 5, 2002.
AHRQ sought input on the preliminary measure set for the first NHDR from stakeholders and other interested parties through December 13, 2002. Of special interest to the agency was input on the individual measures included and the overall balance, comprehensiveness, and robustness of the measure set. While obtaining input, AHRQ began relevant data analysis for the measures in the preliminary measure set. Based on the input and the results of analyses, and with broad input from throughout HHS, final decisions were made on which measures would be included in the first NHDR.
Multiple Reporting Products
AHRQ conducted audience research to identify the needs of potential audiences in an effort to develop a final product that meets those needs. Results indicated two main audience groups:
- Policymakers and others who seek the bottom line without significant detail.
- "Analysts" who want the information in greater detail.
The 2003 report to Congress was designed to meet the needs of both audiences. It included a short summary report that highlights the key points from the analysis (for the policy audience) and appendixes that include technical specifications and detailed tables for all of the measures (for the analyst audience). All appendixes, as well as full report text, are available on AHRQ's QualityTools Web site.