Patient Safety and Quality

The rate of care quality improvement has slowed, but nurses are well-positioned to advocate for quality, equitable care

The rate of quality improvement in care has slowed. Nurses, in particular, are well-positioned to advocate on behalf of all patients for higher quality, more equitable care. Agency for Healthcare Research and Quality (AHRQ) researchers, Karen Ho, M.H.S., and Jeffrey Brady, M.D., M.P.H., along with AHRQ director Carolyn M. Clancy, M.D., summarize findings from the fifth annual National Healthcare Quality Report and National Healthcare Disparities Report to underscore the slow progress in quality improvement in a recent commentary.

The reports showed that while some areas of health care made important gains, overall quality improved by an average of only 1.5 percent per year between 2000 and 2005. This took place despite ongoing efforts around the country to improve care quality and reduce disparities.

The 2007 reports showed some notable gains, such as the portion of heart attack patients who received recommended tests, medications, or counseling to quit smoking, and the reduction in disparities in childhood vaccines among blacks, Asians, and Hispanics. Measures of patient safety, however, showed an average annual improvement of only 1 percent. These areas included how many Medicare surgery patients had not received timely antibiotics to prevention infection, the portion of elderly patients who had been given potentially harmful prescription drugs, or how many patients developed post-surgery complications.

There were notable opportunities for improvement such as the lack of improvement in communication between hospital patients and their physicians and nurses about new medications and discharge information, which even worsened for some age groups between 2005 and 2007. Also troubling was the lack of diversity among the nursing workforce; nearly 82 percent of registered nurses (RNs) in 2004 were white. However, the number of racial/ethnic minority RNs increased threefold from 1980 to 2004 from 119,512 to 311,177.

More details are in "Improving quality and reducing disparities: The role of nurses," by Ms. Ho, Dr. Brady, and Dr. Clancy, in the July-September Journal of Nursing Care Quality 23(3), pp. 185-188. Reprints (AHRQ Publication No. 08-R085) are available from the AHRQ Publications Clearinghouse.

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