On December 22, HHS Secretary Tommy G. Thompson released two reports that represent the first national comprehensive effort to measure the quality of health care in America and differences in access to health care services for priority populations.
The reports, the National Healthcare Quality Report and the National Healthcare Disparities Report, provide baseline views of the quality of health care and differences in use of the services. Future reports will help the Nation make continuous improvements by tracking quality through a consistent set of measures that will be updated as new measures and data become available.
The reports point to an important priority for HHS to ensure that all Americans have the safest, highest quality health care services possible available to them when needed. They reports were prepared by the Agency for Healthcare Research and Quality as directed by Congress.
The reports present data on the quality of services and differences in access to services for seven clinical conditions, including cancer, diabetes, end-stage renal disease, heart disease, HIV and AIDS, mental health, and respiratory disease. The reports also include data on maternal and child health, nursing home and home health care, and patient safety. The measures included in the reports provide an important snapshot of the Nation's health care system.
The National Healthcare Quality Report offers hopeful signs in many areas. For example:
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The majority of women are screened for breast cancer (70 percent of women over 40 within the previous 2 years) and cervical cancer (81 percent of women 18 and over within the previous 3 years).
- Almost 90 percent of in-center kidney dialysis patients get adequate dialysis.
- Approximately 83 percent of women have prenatal care in their first trimester.
- Over 80 percent of Medicare enrollees hospitalized with pneumonia get blood cultures before they are given an antibiotic, get their initial antibiotic within 8 hours, and get the type of antibiotics they need consistent with current clinical guidelines.
The report also indicates that greater improvement in health care quality is possible.
For example:
- Rates of children who are admitted to the hospital for asthma are 29.5 per 10,000.
- Only about 20 percent of patients prescribed a medication to treat diagnosed depression have at least three recommended followup visits to monitor their medication in the 12 weeks after diagnosis.
- Sixty-two percent of smokers who had a routine office visit reported that their doctors had advised them to quit. At the same time, less than half of acute heart attack patients who smoked were counseled to quit while in the hospital (42 percent).
- Rates for blood pressure screening are 90 percent, and rates for cholesterol screening in adults 45 or older are more than 80 percent. However, only about 25 percent of people with high blood pressure have it under control.
The National Healthcare Disparities Report presents data on the same clinical conditions and other measures as the Quality Report as they apply to the priority populations, including women, children, the elderly, racial and ethnic minority groups, low income groups, residents of rural areas, and individuals with special health care needs, specifically children with special needs, people with disabilities, people in need of long-term care, and people requiring end-of-life care.
The report indicates that priority populations do as well or better than the general population in some aspects of health care.
For example:
- Asians and Pacific Islanders, American Indians/Alaskan Natives, and Hispanics have a lower death rate from all cancers.
- Blacks have higher rates of Pap smears and blood pressure monitoring and lower rates of postoperative hip fracture compared with whites.
- Black and Hispanic patients are more likely than others to report that their health care provider usually asks about medications prescribed by other doctors.
- Hispanics and Asians and Pacific Islanders have lower rates of hospitalization from influenza than other groups.
However, there is room for improvement in other areas. For example:
- People of lower socioeconomic status (SES) and blacks have higher death rates for all cancers combined.
- Hispanics and American Indians and Alaska Natives are less likely than others to have their cholesterol checked.
- People of lower SES and some minorities are less likely to have a usual source of care.
- Rates of hospital admissions for conditions that are usually treatable outside the hospital are generally higher for people who live in low income areas compared with those who live in high income areas.
The reports are available on a new Web site, www.qualitytools.ahrq.gov.
The site serves as a Web-based clearinghouse to make it easier for health care providers, health plans, policymakers, purchasers, patients, and consumers to take effective steps to improve quality.
Print copies of the reports (AHRQ Publication No. 04-RG003, quality; 04-RG004, disparities) are available from the AHRQ Publications Clearinghouse.
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