• Key informant interviews, scientific publications, grey literature, and discussions with AHRQ's NHQDR team identified diverse quality of care frameworks that informed a proposed update of the NHQDR framework.
• The update shows person-centeredness as the overarching domain that guides all care decision, depicts equity as the lens through which we evaluate quality of care and identify disparities, emphasizes the key role of access to care, adds healthcare characteristics to address drivers of health, expands types of care, and adds care settings covered in the NHQDR to the framework.
• Future work should focus on revisiting the purpose and audience of the NHQDR, and discussing the extension of the framework from quality of healthcare to population health.

Background and objectives. The Agency for Healthcare Research and Quality (AHRQ)’s National Healthcare Quality and Disparities Report (NHQDR) summarizes the status of healthcare delivery in the U.S. The objective of this technical brief is to provide considerations for updating the framework guiding the NHQDR.

Review methods. The technical brief combined input from key informants, formal literature review searches, grey literature sources, and discussions with the AHRQ NHQDR program team. Literature searches were executed in December 2023 and will be updated during public posting of the report.

Findings. We identified 149 quality of care frameworks and conducted key informant interviews with six content experts. Results are documented in comprehensive evidence tables and a compendium of published frameworks. Published frameworks varied considerably in their scope, domains, and inclusion of equity. We identified areas of the current NHQDR framework that could be updated. This included adding aspects that were currently missing in the framework but that were highlighted as important in the literature, highlighted by content experts, or reflected in what is currently reported in the NHQDR. The process also uncovered areas that were outside the scope of updating of the existing framework and that could be the subject of further conceptual work. The proposed framework continues to address healthcare performance and differentiates 9 domains of quality of care and care disparities, including the overarching domain person-centeredness, foundational domains (access, coordination, healthcare characteristics addressing drivers of health), performance-indicating domains (effectiveness, safety, timeliness, efficiency), and a crosscutting domain (equity). Specific proposed updates include introducing person-centeredness as an overarching and guiding domain, establishing equity as a lens through which we evaluate care quality and identify disparities, emphasizing the key role of access to care, adding healthcare characteristics to address drivers of health, expanding types of care and care settings.  

Conclusion. A substantial number of quality of care frameworks can inform the NHQDR, but frameworks vary widely in their scope and inclusion of equity and drivers of health. We proposed updates to the NHQDR framework to better align with current focus and priority areas. Future work should focus on revisiting the aim and purpose of the NHQDR, assessing the needs and preferences of the audience using the yearly report and web-based tools, and discussing the extension of the framework to incorporate population health.

Updating the Framework for Agency for Healthcare Research and Quality's National Healthcare Quality and Disparities Report. Technical Brief No. XX. (Prepared by [deidentified] under Contract No. ##.) AHRQ Publication No. XX-EHCXXX-EF. Rockville, MD: Agency for Healthcare Research and Quality; month year. DOI: XX. Posted final reports are located on the Effective Health Care Program search page.