Notice2025-03752
Request for Information Regarding Diagnostic Excellence Measurement; Reopening of Comment Period
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
March 10, 2025
Issuing agencies
Health and Human Services DepartmentAgency for Healthcare Research and Quality
Abstract
The Agency for Healthcare Research and Quality (AHRQ) invites public comment in response to this Request for Information (RFI) on the development of measures of diagnostic excellence that may be calculated using administrative data or electronic health record (EHR) data. The purpose of diagnostic excellence measurement is to identify potential opportunities to improve the diagnostic process at a health system or geographic level. AHRQ welcomes comments on the importance and usability of existing measures and those that may be under development.
Full Text
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<title>Federal Register, Volume 90 Issue 45 (Monday, March 10, 2025)</title>
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[Federal Register Volume 90, Number 45 (Monday, March 10, 2025)]
[Notices]
[Pages 11608-11609]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-03752]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Information Regarding Diagnostic Excellence
Measurement; Reopening of Comment Period
AGENCY: Agency for Healthcare Research and Quality, U.S. Department of
Health and Human Services.
ACTION: Notice; reopening of comment period.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) invites
public comment in response to this Request for Information (RFI) on the
development of measures of diagnostic excellence that may be calculated
using administrative data or electronic health record (EHR) data. The
purpose of diagnostic excellence measurement is to identify potential
opportunities to improve the diagnostic process at a health system or
geographic level. AHRQ welcomes comments on the importance and
usability of existing measures and those that may be under development.
DATES: The comments due date for the notice published on December 12,
2024, at 89 FR 100497, is reopened. Comments must be received by March
10, 2025.
ADDRESSES: Interested parties may submit comments electronically to
<a href="/cdn-cgi/l/email-protection#8cfde5fff9fcfce3fef8ccede4fefda2e4e4ffa2ebe3fa"><span class="__cf_email__" data-cfemail="aedfc7dddbdedec1dcdaeecfc6dcdf80c6c6dd80c9c1d8">[email protected]</span></a> with the subject line ``Diagnostic Excellence
Measurement.''
FOR FURTHER INFORMATION CONTACT: Questions may be addressed to Judy
George, <a href="/cdn-cgi/l/email-protection#b7ddc2d3ce99d0d2d8c5d0d2f7d6dfc5c699dfdfc499d0d8c1"><span class="__cf_email__" data-cfemail="731906170a5d14161c01141633121b01025d1b1b005d141c05">[email protected]</span></a>, (301) 427-1717.
SUPPLEMENTARY INFORMATION: The COVID-19 pandemic led to disruptions in
healthcare service delivery and reversed some of the gains made in
patient safety over the previous two decades. In 2024, AHRQ on behalf
of HHS, officially launched the National Action Alliance for Patient
and Workforce Safety (<a href="https://www.ahrq.gov/action-alliance/index.html">https://www.ahrq.gov/action-alliance/index.html</a>),
a collaboration between public and private partners to recommit to
patient and workforce safety and to eliminate preventable harm in
healthcare. Diagnostic safety events are an important contributor to
patient safety, with diagnostic errors potentially impacting millions
of U.S. residents each year (<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5502242/">https://pmc.ncbi.nlm.nih.gov/articles/PMC5502242/</a>). Diagnostic error is ``the failure to (a) establish an
accurate and timely explanation of the patient's health problem(s) or
(b) communicate that explanation to the patient'' (<a href="https://doi.org/10.17226/21794">https://doi.org/10.17226/21794</a>). However, in order to improve patient safety, a focus
on diagnostic error reduction alone is not sufficient. Efforts are
needed to improve the diagnostic process as a whole, with an emphasis
on diagnostic excellence.
Diagnostic excellence may be defined as ``an optimal process to
attain an accurate and precise explanation about a patient's
condition'' (<a href="https://jamanetwork.com/journals/jama/article-abstract/2785845">https://jamanetwork.com/journals/jama/article-abstract/2785845</a>). This process should be ``timely, cost-effective, convenient,
and understandable to the patient.'' Diagnostic excellence ``embraces
the six dimensions of quality enumerated by the Institute of Medicine
in 2001: care that is safe, effective, patient-centered, timely,
efficient, and equitable'' (<a href="https://jamanetwork.com/journals/jama/article-abstract/2785845">https://jamanetwork.com/journals/jama/article-abstract/2785845</a>).
Several efforts have been underway to develop measures that provide
information on the state of diagnostic excellence, including research
funded by AHRQ and the Gordon and Betty Moore Foundation. The AHRQ
Quality Indicators (QI) Program develops indicators of healthcare
quality and patient safety in a variety of healthcare settings. The QI
Program is actively engaged in collecting information on measures that
can contribute to diagnostic excellence measurement. AHRQ is
considering measures that rely on administrative claims data (for state
and regional health departments with limited access to clinical data),
as well as electronic health record data (for healthcare systems with
full access to clinical data). AHRQ aims to address gaps in diagnostic
excellence measurement with a population health lens and with the
following goals:
1. Develop a starter set of standardized measures to support
population-level diagnostic excellence surveillance.
[[Page 11609]]
2. Generate measures that are accessible and applicable across
different types of users, especially those with limited access to
clinical data sources.
3. Produce national benchmarks for population-level surveillance of
diagnostic excellence.
4. Foster healthcare quality improvement in the area of diagnostic
excellence.
AHRQ requests information from the public on existing measures that
may be used in diagnostic excellence measurement and others that may be
under development.
Criteria. Diagnostic excellence measures should be important,
scientifically acceptable, feasible, and useful. These concepts are
defined as follows:
Important. (1) There is evidence linking the measure to important
outcomes (including either process outcomes or clinical outcomes); (2)
there is evidence of inequalities across groups or opportunity for
improvement on that measure; or (3) the target population of the
measure (e.g., patients) or users of the measure (e.g., researchers,
providers) value the measurement and find it meaningful.
Scientifically acceptable. A scientifically acceptable measure is
both (1) valid (the measure accurately represents the concept it is
trying to measure) and (2) reliable (the measure consistently produces
the same result over time and in different contexts).
Feasible. A measure is feasible if it is possible to implement with
existing data systems and clinical processes.
Useful. A measure is useful if it provides information useful for
quality improvement programs, with the ability to capture variation in
performance across reporting entities.
Additional Considerations. In addition to the criteria listed
above, AHRQ aims to consider the extent to which measures:
<bullet> Identify an important gap in diagnostic performance;
<bullet> Contribute to the solution of a diagnostic safety problem;
<bullet> Are broadly applicable to a population-level diagnostic
safety opportunity;
<bullet> Could be used to lessen health disparities.
AHRQ requests responses to the following questions:
1. Are you currently working on any initiatives related to
diagnostic excellence, diagnostic safety, or diagnostic quality? If so,
please describe. If you are working on diagnostic excellence
initiatives, which ones would benefit from publicly available
measurement tools or resources? Are there specific resources that you
would like to see from AHRQ? If so, please describe.
2. If you are currently measuring diagnostic excellence in your
organization, what measure(s) are you using? How do you use these
measures (e.g., for quality improvement efforts, to track population
health) and what motivated the use of such measures? What data sources
are you using? What data model are you using to map data to
standardized concepts (e.g., Observational Medical Outcomes Partnership
(OMOP) Common Data Model, others)? Please specify your organization
type (e.g., state/local health department, professional society,
healthcare system, research organization, etc.) in your answer.
3. If you or your organization are not currently measuring
diagnostic excellence, what diagnostic excellence measures might be
helpful to your organization? Please specify your organization type in
your answer.
4. If standardized measures with national benchmarks were made
available through software by AHRQ, how likely would you be to use
them? What characteristics (e.g., risk adjustment, frequency counts) or
features (e.g., statistical programming languages, data model
platforms, technology [web or cloud-based applications]) of such
measures would facilitate their use and usefulness within your
organization?
5. AHRQ is considering the diagnostic excellence-related measures
listed here: <a href="https://bit.ly/41mg3i6">https://bit.ly/41mg3i6</a>. We invite comments on:
a. The extent to which these measures meet the ``Criteria'' listed
above; and
b. The extent to which these measures address the ``Additional
Considerations'' listed above.
6. AHRQ invites any additional comments related to potential AHRQ
measures of diagnostic excellence.
AHRQ is interested in all of the questions listed above, but
respondents are welcome to address as many or as few as they choose and
to address additional areas of interest not listed. It is helpful to
identify the question to which a particular answer corresponds.
This RFI is for planning purposes only and should not be construed
as a policy, solicitation for applications, or as an obligation on the
part of the Government to provide support for any ideas in response to
it. AHRQ will use the information submitted in response toto this RFI
at its discretion and will not provide comments to any respondent's
submission. However, responses to this RFI may be reflected in future
solicitation(s) or policies. The information provided will be analyzed
and may appear in reports.
Dated: March 4, 2025.
Marquita Cullom,
Associate Director.
[FR Doc. 2025-03752 Filed 3-7-25; 8:45 am]
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