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[Federal Register Volume 89, Number 239 (Thursday, December 12, 2024)]
[Notices]
[Pages 100497-100498]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-29134]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

Request for Information Regarding Diagnostic Excellence 
Measurement

AGENCY: Agency for Healthcare Research and Quality, Department of 
Health and Human Services.

ACTION: Notice of Request for Information (RFI) regarding diagnostic 
excellence measurement.

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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: Comments on this notice must be received by February 13, 2025.

ADDRESSES: Interested parties may submit comments electronically to 
[email protected] with the subject line ``Diagnostic Excellence 
Measurement.''

FOR FURTHER INFORMATION CONTACT: Questions may be addressed to Judy 
George, [email protected], (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 (https://www.ahrq.gov/action-alliance/index.html), 
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 (https://pmc.ncbi.nlm.nih.gov/articles/PMC5502242/). 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'' (https://doi.org/10.17226/21794). 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'' (https://jamanetwork.com/journals/jama/article-abstract/2785845). 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'' (https://jamanetwork.com/journals/jama/article-abstract/2785845).
    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.
    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.

[[Page 100498]]

    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:
     Identify an important gap in diagnostic performance;
     Contribute to the solution of a diagnostic safety problem;
     Are broadly applicable to a population-level diagnostic 
safety opportunity;
     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: https://bit.ly/41mg3i6. 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: December 6, 2024.
Marquita Cullom,
Associate Director.
[FR Doc. 2024-29134 Filed 12-11-24; 8:45 am]
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