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Chapter 2. Quality of Health Care
The U.S. health care system is considered to be among the world's best. As better understanding of health and sickness have led to superior ways of preventing, diagnosing, and treating diseases, the health of most Americans has improved dramatically. However, ample evidence indicates that some Americans do not receive the full benefits of high quality care. Specifically, disparities in health care related to race, ethnicity, and socioeconomic status (SES) have been demonstrated by much research and confirmed by the first National Healthcare Disparities Report (NHDR).
Components of Health Care Quality
Quality health care means doing the right thing, at the right time, in the right way, for the right people—and having the best possible results1. Quality health care is care that is:
- Effective— Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit.
- Safe— Avoiding injuries to patients from the care that is intended to help them.
- Timely— Reducing waits and sometimes harmful delays for both those who receive and those who give care.
- Patient centered— Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
- Equitable— Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
- Efficient— Avoiding waste, including waste of equipment, supplies, ideas, and energy2.
Health care quality is measured in several ways including:
- Clinical performance measures— Measures of how well providers deliver specific services needed by specific patients, such as whether children get the immunizations that they need.
- Patient assessments— Measures of how well providers meet health care needs from the patient's perspective, such as whether providers communicate clearly.
- Outcomes of care— Measures of health that may be affected by the quality of health care received, such as death rates from cancers that can be prevented by screening.
The measures used in this chapter are the same as those used in the National Healthcare Quality Report (NHQR). Because outcome measures like mortality are strongly affected by factors other than health care, such as genetic predisposition, lifestyle, comorbid conditions, and environmental and social determinants, process measures are highlighted in this report. Outcome measures are included in the quality of care measure set and presented in the summary and detailed tables because they add to understanding of disparities. Disparities in delivery of specific health care services that are associated with worse outcomes merit more attention than disparities in health care not associated with differences in outcomes.
How This Chapter Is Organized
This chapter presents new information about disparities in quality of health care in America. It is constructed to mirror sections in the NHQR—effectiveness, patient safety, timeliness, and patient centeredness. Effectiveness of care is presented under nine priority areas: cancer, diabetes, end stage renal disease (ESRD), heart disease, HIV and AIDS, maternal and child health, mental health, respiratory diseases, and nursing home and home health care.
As in the 2003 NHDR, the discussion on quality of care in this chapter focuses on disparities in quality of care related to race, ethnicity, and SES in the general U.S. population. Disparities in quality of care within specific priority populations are presented in Chapter 4.
In addition to new data on quality of care, this chapter goes beyond the 2003 NHDR and adds analyses of changes over time, as well as some stratified and multivariate analyses. To present this greater detail, individual sections of Chapter 2 highlight a small number of measures, where applicable. Results for all measures are found in the summary tables at the end of the chapter.