Quality of Nation's Health Care 'Fair' But Slowly Improving

Health Care Quality, Disparity Reports Track U.S. Progress

June 03, 2014 02:52 pm News Staff

For the 11th consecutive year, the Agency for Healthcare Research and Quality has released complementary reports that assess the U.S. health care system’s performance in the areas of health care quality, access and disparities in care.

The two reports -- the 2013 National Healthcare Quality Report(www.ahrq.gov)
and the National Healthcare Disparities Report(www.ahrq.gov) -- provide information on hundreds of health care measures categorized into specific areas such as effectiveness, patient safety, timeliness, care coordination, efficiency and access to care. As with previous reports, data years covered vary across measures, although most trend analyses included data points from 2000-02 to 2010-11.

The reports address three key questions:

  • What is the status of health care quality, access and disparities in the United States?
  • How have the levels of those three measures changed over time?
  • Where are health care quality, access and disparities improving, and where are these markers of care getting worse?
Story highlights
  • The Agency for Healthcare Research and Quality recently released its 2013 National Healthcare Quality Report and National Healthcare Disparities Report.
  • Researchers rated the quality of U.S. health care as “fair,” access to care also as just fair, and the level of health care disparities as “poor.”
  • The researchers noted that the 2013 reports provide a snapshot of the U.S. health care system prior to implementation of the Patient Protection and Affordable Care Act and said this year’s reports would serve as a baseline for tracking progress in future years.

The reports’ authors pointed out that the documents provide a snapshot of health care prior to implementation of the Patient Protection and Affordable Care Act and would serve as a baseline against which to track progress in upcoming years.

Measuring Quality

Quality measures assessed include immunizations; counseling about smoking, weight loss and exercise; treatment of diabetes and pneumonia; and a host of others. Overall, researchers rated the quality of health care in America as “fair.” On average, in 2010, Americans received 70 percent of indicated health care services. That means they failed to receive 30 percent of the care needed to treat or prevent specific medical conditions, the authors said.

“The gap between best possible care and what is routinely delivered remains substantial across the nation,” they added.

The authors also noted that the quality of care is improving, but slowly. In 2005, for example, patients got about 66 percent of the health care services they should have received compared with the 70 percent figure seen in 2010.

Furthermore, quality of care on some measures improved among all population groups. Across all measures of health care quality tracked, 60 percent showed improvement. It should be noted, however, that although improvement occurred among all racial, ethnic and income groups, a smaller proportion of measures showed improvement among American Indians and Alaska Natives.

Improvement in meeting quality measures was more rapid in hospital settings (75 percent) than in home health, hospice and nursing home (60 percent) or ambulatory settings (about 50 percent), according to the reports.

Researchers suggested that hospitals, nursing homes, and home health and hospice agencies may have more infrastructure in place that allows them to improve quality and respond to performance measurement compared with health care professionals in ambulatory settings.

Quality measures with the highest rates of improvement or decline, as well as those that have been retired because they achieved a 95 percent overall performance level, are highlighted in a single table. In addition, since 2005, a state snapshots tool(nhqrnet.ahrq.gov) has allowed users to evaluate variations in health care quality across states.

Assessing Access

Discussions of health care quality are moot, of course, for Americans unable to enter the health care system, the authors noted. They measured access by looking at, among other things, whether patients had health insurance and a regular health care professional, and they also took into account patients’ perceptions of difficulties and delays when trying to obtain health care.

Overall, the authors concluded that access to health care in the United States was only fair because in 2011, 26 percent of Americans, on average, reported barriers that restricted their access to care.

The one access measure that improved during the period covered by the reports was patients’ ability to contact their usual source of health care about a health problem by telephone during usual business hours.

Access measures that worsened in that period were:

  • people younger than 65 who had private health insurance,
  • adults ages 65 and older who had private health insurance,
  • people younger than 65 who were uninsured all year,
  • people without a usual source of care who indicated a financial or insurance problem as the cause, and
  • people who could not get – or who were delayed in getting – needed medical care, dental care or prescription medications in a timely manner because of financial or insurance reasons.

Tracking Disparities

“Some Americans routinely face more barriers to care and receive poorer quality of care when they can get it,” said the authors. They rated the U.S. health care system overall as poor when it came to disparities.

Some key disparities among different racial and ethnic groups – and also between poor and high-income people – that were highlighted in the report included:

  • Black and Hispanic patients received worse health care than white patients for about 40 percent of quality measures.
  • American Indians and Alaska Natives received worse care than white patients for about 33 percent of quality measures.
  • Asian patients received better care than white patients for about 30 percent of quality measures and worse care for about 25 percent of measures.
  • Poor people received worse care than high-income people for about 60 percent of quality measures.

New to this year’s report was a comparison of care disparities among people with activity limitations and those with no such limitations. Also included was a table showing the disparities that have been changing the most rapidly over time. For example, a comparison of black and white patients shows that hospital admission rates among black patients 18 and older with uncontrolled diabetes improved. But the maternal death rate per 100,000 live births worsened among blacks.

Looking to the Future

The report stated that to remain competitive, the United States must improve access to care, reduce disparities and accelerate the pace of quality improvement, with a focus on preventive care and chronic disease management.

“Information needs to be disseminated more quickly to partners who have the skills and commitment to change health care,” said the authors. Building on the reports and state snapshots, “stakeholders can design and target strategies and clinical interventions to ensure that all patients receive the high-quality care need to make their lives better,” they concluded.

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