Health care in America is far from perfect, according to a pair of reports just released by the Agency for Healthcare Research and Quality (AHRQ). Report authors conclude that overall quality of care is improving, but access to care is worsening, and efforts to improve disparities in care have flat-lined.
AHRQ's 10th iterations of the National Healthcare Quality Report(www.ahrq.gov) and the National Healthcare Disparities Report(www.ahrq.gov) include a single summary chapter that wraps up highlights of both reports.
Researchers combed through more than 36 databases and reviewed trends that dominated the health care landscape in 2009 and 2010 to produce the reports. The full set of measures tracked in the reports includes measures related to access to health care, such as whether a patient has health insurance and a regular health care professional. Measures of care quality include whether a patient has receivedspecific services to treat or prevent a medical condition, as well as outcomes of treatment.
- The AHRQ recently released the National Healthcare Quality Report 2012 and the National Healthcare Disparities Report 2012.
- The two reports, produced annually for the past decade, focus on the status of health care in America, including health care quality, disparities and access to care.
- The report concludes that the overall quality of care is improving but that access to care is declining, and efforts to improve disparities in care have stalled.
The reports address three questions that, according to the authors, are "critical to guiding Americans toward the optimal health care they need and deserve." Those questions are:
- What is the status of health care quality and health care disparities?
- How have quality and disparities changed during the course of time?
- Where in the U.S. health care system are improvements most needed?
The authors conclude that access to care and quality of care received are "suboptimal," particularly for minority and low-income populations, and they raise a red flag regarding the urgency with which health care disparities need to be addressed.
They also are calling for "urgent attention" to particular health issues to ensure continued improvements in
- quality of diabetes care, maternal and child health care, and adverse events;
- disparities in cancer care; and
- quality of health care delivered in some Southern states.
The report on quality of care indicates that the quality of health care for Americans is improving slowly for all racial, ethnic and income groups. In fact, across all measures of health care quality tracked in the reports, nearly 60 percent showed improvement. For example, in 2005, patients failed to receive about 34 percent of the recommended health care services, but that percentage dropped to 30 percent in 2009.
However, the authors note that even as problems with the quality of care are decreasing, access issues are on the rise. Between 2002 and 2009, the ability of Americans to access health care worsened by two percentage points. In 2002, 24 percent of patients reported trouble with health care access compared to 26 percent in 2009.
When looking at all of the measures of access tracked in the report, only one showed improvement and nearly half were getting worse. Furthermore, the report notes that for most demographic groups, "the number of access measures that were getting worse exceeded the number that were improving."
The report on disparities concludes that disparities in quality of care are common. For example, poor and low-income people received worse care than high-income people for about 60 percent of quality measures, and people in the middle-income range received worse care for more than half the measures.
Looking at quality measures, Caucasian patients received -- in differing percentages -- better health care than blacks, Hispanics, American Indians and Alaska Natives. On the other hand, Asians received worse care than Caucasians for about 25 percent of certain quality measures but better care for another 25 percent of quality measures.
The report also notes that disparities in access to care are common. Poor people had worse access to care than high-income people for all measures. People in the low-income bracket experienced worse access to care for more than 80 percent of measures, and those in the middle-income bracket saw worse access to care for 70 percent of measures.
Caucasians experienced the best access to care of all demographic groups with the exception of one group of measures for which Asians had 20 percent better access.
The summary pages of the reports include tables and graphics to help highlight specific information. For example, one table lists improved quality measures alongside measures that deteriorated. Solid improvement was shown in
- adult surgery patients who received prophylactic antibiotics within one hour before surgical incision,
- hospital patients age 65 and older with pneumonia who received a pneumococcal screening or vaccination, and
- hospital patients with heart failure who were given complete written discharge instructions.
Quality deteriorated for several measurements, including
- maternal deaths per 100,000 births,
- adults ages 40 and older with diagnosed diabetes who received yearly foot checks, and
- women ages 21-65 who had received a Pap smear in the past three years.
A table highlighting changes in disparities also includes lists -- broken down by demographic groups -- of disparities that improved and those that worsened.
In addition, the report includes four separate maps of the United States that highlight overall quality of care, preventive care, acute care and chronic care by state. Authors note that states in different parts of the country face different patterns of health care quality. For example,
- states in the New England and West North Central census divisions performed well on preventive, acute and chronic care quality measures, but states in the East South Central and West South Central divisions performed poorly on all three types of services;
- states in the Mountain division performed poorly on preventive and acute care;
- states in the East North Central division performed well on acute care but poorly on chronic care, and
- states in the South Atlantic division performed well on preventive care but poorly on chronic care.
Report authors conclude that the statistics gathered for the reports should be used to create policies and initiatives that will improve the lives of patients.
"It makes a difference in people's lives when breast cancer is diagnosed early; when a patient having a heart attack gets the correct life-saving treatment in a timely fashion; when medications are correctly administered; and when doctors listen to their patients and families, show them respect, and answer their questions in a culturally and linguistically skilled manner. All American should have access to quality care that helps them achieve the best possible health," concludes the report.