2007 AHRQ Reports
Improvement in Health Care Quality Slows While Disparities Persist
By Jessica Pupillo
4/9/2008
The growing call among health care professionals, legislators, health policy-makers, consumer advocates, and the public to boost the overall quality of health care provided in the United States has led to advances in quality. However, according to findings from two new annual reports published by the Agency on Healthcare Research and Quality, or AHRQ, the overall rate of improvement is slowing. Similarly, although progress has been made in addressing some health care disparities among various racial, ethnic and socioeconomic groups, overall inequalities in health care among different patient populations have not improved.
The reports, which are mandated by Congress, rely on the latest available data drawn from more than three dozen databases, most sponsored by federal health agencies. These latest reports used data from 2004 and 2005, depending on the specific data source.
Quality of Care
Between 1994 and 2005, the quality of health care improved an average of 2.3 percent each year across all core measures, according to AHRQ's 2007 National Healthcare Quality Report (144-page PDF; About PDFs). However, an analysis of selected core measures, which cover data from 2000 to 2005, shows that quality improvement has slowed to an annual rate of only 1.5 percent.
"Health care quality is improving only modestly, at best," said AHRQ Director Carolyn Clancy, M.D., in a press release about the AHRQ reports. "Given that health care spending is rising much faster, these findings about quality underscore the urgency to improve the value Americans are getting for their health care dollars."
Areas of significant improvement include care for patients who have heart attacks, the report found. More than 93 percent of these patients received recommended hospital care in 2005, up from about 77 percent in 2000-2001. In addition, more health care professionals are talking to patients who've had heart attacks about smoking; nearly 91 percent of these patients were counseled to quit smoking in 2005, up from almost 43 percent in 2000-2001.
And despite the fact that overall patient safety saw only a 1 percent improvement each year from 2002 to 2005 -- based on an assessment of factors such as the proportion of elderly patients who had been given potentially harmful prescription drugs and the number of patients who developed postsurgical complications -- areas that received significant attention saw significant advances. For example, 30 percent more patients received appropriately timed antibiotics before and after surgery in 2005 than 2004.
"Health care quality is improving only modestly, at best," said AHRQ Director Carolyn Clancy, M.D., in a press release about the AHRQ reports. "Given that health care spending is rising much faster, these findings about quality underscore the urgency to improve the value Americans are getting for their health care dollars."
Areas of significant improvement include care for patients who have heart attacks, the report found. More than 93 percent of these patients received recommended hospital care in 2005, up from about 77 percent in 2000-2001. In addition, more health care professionals are talking to patients who've had heart attacks about smoking; nearly 91 percent of these patients were counseled to quit smoking in 2005, up from almost 43 percent in 2000-2001.
And despite the fact that overall patient safety saw only a 1 percent improvement each year from 2002 to 2005 -- based on an assessment of factors such as the proportion of elderly patients who had been given potentially harmful prescription drugs and the number of patients who developed postsurgical complications -- areas that received significant attention saw significant advances. For example, 30 percent more patients received appropriately timed antibiotics before and after surgery in 2005 than 2004.
Get State-by-State Performance Comparisons
Wondering how health care quality in your state compares to national and regional averages and best performers? You'll find that information and much more on AHRQ's 2007 State Snapshots Web site.
Features on the site include:
Features on the site include:
- state dashboard -- offers a quick, one-stop view of your state's performance on various measures of health care quality;
- focus on Healthy People 2010 -- shows your state's performance on many of the Healthy People 2010 goals established by HHS;
- focus on clinical preventive services -- indicates your state's performance on services recommended by the U.S. Preventive Services Task Force and the CDC's Advisory Committee on Immunization Practices; and
- contextual factors -- 13 dials represent various aspects of your state's environment in the areas of demographic characteristics, population health status and health care resources.
The report also points out several instances in which quality measures declined or remained flat, indicating "missed opportunities" for care and disease prevention, said Cmdr. Jeff Brady, M.D., M.P.H., who oversees production of AHRQ's national health care reports. Among those findings:
- a smaller percentage of women age 40 or older are receiving mammograms every two years;
- among patients with diabetes, gains were made in controlling total cholesterol, but there was no improvement in controlling hemoglobin A1c levels or blood pressure;
- the percentage of obese adults who were advised about exercise remained the same between 2002 and 2004;
- between 1999 and 2004, less than 40 percent of overweight kids ages 2 years to 19 years were told by a health care professional that they were overweight; and
- there was no significant improvement in the treatment of depression between 2004 and 2005, with only about 65 percent of people reporting depression actually getting treatment.
The 2007 National Healthcare Disparities Report (252-page PDF; About PDFs) from AHRQ found that overall inequalities in health care quality and access among different racial, ethnic and socioeconomic groups have not improved.
Progress has been made in a few areas. For example, the disparity between Asians and whites who had a usual primary care provider has been eliminated, and significant improvements in childhood vaccines have been made in most so-called priority populations.
However, compared with white patients,
Progress has been made in a few areas. For example, the disparity between Asians and whites who had a usual primary care provider has been eliminated, and significant improvements in childhood vaccines have been made in most so-called priority populations.
However, compared with white patients,
- blacks and Hispanics had rates of new AIDS cases that were 10 and 3.5 times higher, respectively;
- Asian adults older than 65 were less likely to be vaccinated against pneumonia; and
- American Indians and Alaska Natives were twice as likely to lack first-trimester prenatal care.
Moreover, children from low-income families were more likely than those from high-income families to experience poor communication with health care professionals.
Uninsurance and Disparities
Lack of health insurance was highlighted in the AHRQ report as a major barrier to reducing health care disparities. Uninsured individuals lag behind those who have at least some private health insurance on 90 percent of quality measures and 100 percent of access measures, the report found.
"Uninsurance can lead to the lack of a usual source of health care and delayed care for necessary services," the report said. "Hispanics and blacks both report lower rates of having a usual source of care and higher rates of delaying necessary care than whites."
The uninsured are six times as likely to be without a usual source of care and three times as likely to delay care for illness or injury, the report found.
"Uninsurance can lead to the lack of a usual source of health care and delayed care for necessary services," the report said. "Hispanics and blacks both report lower rates of having a usual source of care and higher rates of delaying necessary care than whites."
The uninsured are six times as likely to be without a usual source of care and three times as likely to delay care for illness or injury, the report found.
