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In seven years, the United States is expected to reach a demographic tipping point that will redraw the picture of healthcare delivery in America.  

In 2030, all baby boomers will be older than 65, according to the U.S. Census Bureau. Just four years later—in 2034—older adults will outnumber children for the first time in history. The scope of this and future demographic shifts—including our population's growing racial and ethnic diversity—will profoundly impact how healthcare is accessed, delivered, paid for, and evaluated.

AHRQ's efforts to improve healthcare quality and safety have traditionally focused on supporting research and developing tools and resources to improve infrastructure and delivery processes. The Agency has placed less emphasis on developing standards and measures for quality assurance. These distinctions have faded, however, as healthcare has evolved and AHRQ's role in providing evidence for safe, effective care has grown larger.

In recent months, AHRQ’s quest to anticipate and meet the needs of our changing healthcare systems has been aided by the Agency's National Advisory Council for Healthcare Research and Quality—a 21-member panel of private-sector experts who provide advice to the Agency director on its health services research and evidence dissemination and implementation agenda.

Part of that effort has been the formation of a subcommittee that provides strategic guidance on AHRQ's role in quality measurement and assessment. Recommendations delivered by the subcommittee in November 2021 outlined potential new opportunities for AHRQ to enhance quality measurement and standards development activities.

In essence, the subcommittee urged us to step back and rethink our understanding and expectations for quality—particularly in non-acute settings of care that are taking on greater significance as our population ages and diversifies.

I'm excited to report that our months-long exercise has produced compelling new ideas. This summer, the advisory council and AHRQ staff revisited questions about quality and what it means in four healthcare settings that are experiencing rapid changes:

• Nursing Home/Rehabilitation Care.
• Behavioral Healthcare.
• Home Healthcare.
• Hospice Care.

Over the next four days, we hope you'll take the time to read about these topics in a series of AHRQ Views blogs. All of the blogs are authored by National Advisory Council members. And each is intended to reflect the fruitful discussions we've had about the shifting horizons of American healthcare.

We hope these essays spur conversation and new ideas about how to meet the challenges ahead and refocus the healthcare system to meet the future needs of our changing population.

Dr. Valdez is Director of AHRQ.

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