National Healthcare Disparities Report - LDI Health Economist

Introduction and Methods
Chapter 1. Introduction and Methods
In 1999, Congress directed the Agency for Healthcare Research and Quality (AHRQ) to produce an annual
report on “national trends in the quality of health care provided to the American people.” i With support from
the Department of Health and Human Services (HHS) and private-sector partners, AHRQ has designed and
produced the National Healthcare Quality Report (NHQR) to respond to this legislative mandate. The
NHQR provides a comprehensive overview of the quality of health care received by the general population
and is designed to summarize data across a wide range of patient needs—staying healthy, getting better,
living with chronic illness and disability, and coping with the end of life.
AHRQ was further tasked with producing an annual report that tracks “prevailing disparities in health care
delivery as it relates to racial factors and socioeconomic factors in priority populations.” ii Titled the National
Healthcare Disparities Report (NHDR), this report examines disparities in health care received by designated
priority populations. The referenced priority populations consist of groups with unique health care needs or
issues that require special focus, such as racial and ethnic minorities, low-income populations, and people
with special health care needs. AHRQ’s charge includes a directive to examine disparities in health care
access, utilization, costs, outcomes, satisfaction, and perceptions of care.
Chapter 1
The first NHQR and NHDR were significantly shaped by several Institute of Medicine (IOM) reports.
Crossing the Quality Chasm (IOM, 2001) and To Err Is Human (Kohn, et al., 2000) raised awareness about
gaps in the quality of health care and patient safety. The extensive literature review included in the IOM
report Unequal Treatment (IOM, 2003) drew attention to disparities in the care rendered to racial and ethnic
populations, low-income populations, and other vulnerable groups.
Before the publication of the first reports, AHRQ tasked the IOM with developing a vision for the two
reports. With support from an HHS Interagency Work Group and AHRQ’s National Advisory Council,
AHRQ has designed and produced the NHQR and NHDR since 2003.
Changes to the Reports
Over the years, AHRQ introduced several refinements to the NHQR and NHDR measure set and
methodology. These include the following:
n 2004: Goal of the reports was expanded to include tracking of the Nation’s quality improvement
progress.
n 2005: Reports introduced a set of core measures and a variety of new composite measures.
n 2006: Data, measures, and methods were improved; databases and measures were added; and
methods for quantifying and tracking changes in health care were refined.
n 2007: Chapter on health care efficiency was launched.
n 2008: Chapter on patient safety was expanded.
n 2009: New sections were included on lifestyle modification, healthcare-associated infections, and
care coordination.
i
42 U.S.C. 299b-2(b)(2).
ii
42 U.S.C. 299a-1(a)(6).
National Healthcare Disparities Report, 2011
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