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The Agency for Healthcare Research and Quality has released the second edition of two annual reports, one on the quality of health care in America and the other on health care disparities. The 2004 National Healthcare Quality Report finds both evidence of improving quality and specific areas in which major improvements can be made. The 2004 National Healthcare Disparities Report indicates that there are disparities related to race, ethnicity, and socioeconomic status in America's health care system. Both reports extend the baseline data on quality and disparities within health care delivery that were provided in AHRQ's 2003 reports.
The reports measure quality and disparities in four key areas of health care: effectiveness, safety, timeliness, and patient centeredness. They also present data on the quality of and differences in access to services for clinical conditions—including cancer, diabetes, end-stage renal disease, heart disease, and respiratory diseases—and in nursing homes and home health care.
Quality Report. This report identifies three key themes important to policymakers, clinicians, health system administrators, community leaders, and others who work in health care services. The report indicates that:
- Quality is improving in many areas, but change takes time.
- The gap between the best possible care and actual care remains large. Quality of care remains highly variable across the country.
- Further improvement in health care is possible. Best practices have been identified, and collaborative, focused efforts among key stakeholders have produced impressive and inspiring gains.
In comparison to data presented in the 2003 report, modest improvement has been noted in many of the quality measures. Across the entire set of measures included in the report, quality has improved by approximately 3 percent versus data presented in the 2003 report. These include selected measures used by HHS' Centers for Medicare & Medicaid Services, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and others for quality reporting on hospitals, nursing homes, home health agencies, and other settings. In addition, since the 2003 report on quality, improvements have been made in specific measures related to health care delivery.
The greatest changes were in the following:
- A decrease of 37 percent from 2002 to 2003 in the percentage of nursing home patients who have moderate or severe pain.
- A decrease of 34 percent from 1994 to 2001 in the hospital admission rate for uncontrolled diabetes.
- A decrease of 34 percent from 1996 to 2000 in the percentage of elderly patients who were given potentially inappropriate medications.
Although quality remains variable across the country, improvements were seen in many areas at the State level. Some of these notable improvements are:
- Minnesota—Largest improvement in State rank for mammogram testing rates.
- New Jersey—Largest improvement in State rank for administering beta-blockers within 24 hours of hospital admission.
- Alabama—Only State to significantly increase screening rates for two recommended tests for colorectal cancer.
Data for all States are available in the report's Tables Appendix and Measure Specifications Appendix.
Disparities Report. The 2004 National Healthcare Disparities Report presents data on the same clinical conditions and other measures as the Quality Report, but it focuses on 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 in need of long-term care, and people who need end-of-life care.
The 2004 report identifies three key themes:
- Disparities are pervasive.
- Improvement is possible.
- Gaps in information exist, especially for specific conditions and populations.
A subset of measures with the comparable data for 2000 and 2001 is highlighted in the 2004 Disparities Report. In both years:
- Blacks received poorer quality of care than whites for about two-thirds of quality measures and had worse access to care than whites for about 40 percent of access measures.
- Asians received poorer quality of care than whites for about 10 percent of quality measures and had worse access to care than whites for about a third of access measures.
- American Indians and Alaska Natives received poorer quality of care than whites for about one-third of quality measures and had worse access to care than whites for about half of access measures.
- Hispanics received lower quality of care than non-Hispanic whites for half of quality measures and had worse access to care than non-Hispanic whites for about 90 percent of access measures.
- Poor people received lower quality of care for about 60 percent of quality measures and had worse access to care for about 80 percent of access measures than those with high incomes.
The 2004 Disparities Report shows there has been improvement in the care provided to the nation's poor, uninsured, and minorities through federally supported health centers. These centers, which are administered by HHS' Health Resources and Services Administration, focus specifically on providing care to vulnerable populations. In 2004, over 3,600 health center sites delivered primary and preventive care to 13.2 million people. The FY 2006 budget will complete the President's commitment to create 1,200 new or expanded health center sites resulting in the delivery of primary and preventive health care services to 6.1 million additional people, many of whom face multiple barriers to receiving health care. In addition, the President has established a new goal to help every poor county in America that lacks a health center and can support one. Forty new health center sites will be funded in FY 2006 for this new effort.
In addition, AHRQ has recently announced a new partnership designed to help reduce disparities in health care for people with diabetes and other conditions. The National Health Plan Learning Collaborative to Reduce Disparities and Improve Quality is the first national effort of its kind to go beyond research and actively tackle racial and ethnic inequities in health care service delivery. Over the next 3 years, the collaborative will test ways to improve the collection and analysis of data on race and ethnicity, match those data to existing Health Plan Employer Data and Information Set quality measures, develop quality improvement interventions that close the gaps in care, and produce results that can be replicated by other health insurers and providers serving Medicare, Medicaid, and commercial populations.
The National Healthcare Quality Report and National Healthcare Disparities Report are available on AHRQ's Quality Tools Web site at www.qualitytools.ahrq.gov. The site serves as a Web-based clearinghouse to make it easier for health care providers, policymakers, purchasers, patients, and consumers to take effective steps to improve quality. Print copies of the reports (AHRQ Publication numbers 05-0013, Quality; and 05-0014, Disparities) are available from AHRQ's Publication Clearinghouse.
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