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Missed opportunities: Too few Americans are being screened or counseled to prevent colorectal cancer, obesity, and other conditions

The overall quality of the U.S. health care system is improving, but providers are missing important chances to help Americans avoid disease or serious complications, according to annual reports issued by the Agency for Healthcare Research and Quality (AHRQ).

The 2006 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) both found that the use of proven prevention strategies lags significantly behind other gains in health care:

  • Only about 52 percent of adults reported receiving recommended colorectal cancer screenings. About 56,000 Americans die from colorectal cancer, and 150,000 new cases are diagnosed each year. In 2002, the AHRQ-supported U.S Preventive Services Task Force urged initial screenings at age 50 and earlier for people at high risk.
  • Fewer than half of obese adults reported being counseled about diet by a health care professional. About one-third of American adults are obese, increasing the risks of high blood pressure, type 2 diabetes, stroke, heart disease, and osteoarthritis. The Task Force recommends "intensive counseling and behavioral interventions" for obese adults.
  • Only 49 percent of people with asthma said they were told how to change their environment, and 28 percent reported receiving an asthma management plan. Asthma causes about 500,000 hospitalizations annually.
  • Only 48 percent of adults with diabetes received all three recommended screenings—blood sugar tests, foot exams, and eye exams—to prevent disease complications. AHRQ estimates about $2.5 billion could be saved each year by eliminating hospitalizations related to diabetes complications.

The findings from the two annual reports provide updated, congressionally mandated snapshots of the U.S. health care system. AHRQ's reports examine quality and disparities in four key areas of health care: effectiveness of health care, patient safety, timeliness of care, and patient centeredness.

The National Healthcare Quality Report tracks the health care system through quality measures, such as what proportion of heart attack patients received recommended care when they reached the hospital, or what percentage of children received recommended vaccinations. The National Healthcare Disparities Report, meanwhile, summarizes which racial, ethnic, or income groups are most likely to benefit from improvements in health care.

Overall, the review of 40 core quality measures found a 3.1 percent increase in the quality of care—the same rate of improvement as the previous 2 years. Except for vaccinations for children, adolescents, and the elderly, which improved by almost 6 percent, the improvement rate for other preventive measures—screenings, advice, and prenatal care—was less than 2 percent.

The greatest quality gains occurred in U.S. hospitals, where quality improved 7.8 percent. Ambulatory care—health services provided at doctors' offices, clinics or other settings without an overnight stay—improved by 3.2 percent. Nursing home and home health care improved by 1 percent.

As in previous years, the Federal disparities report found access to care varied widely between racial, ethnic, and economic groups. Blacks received poorer quality care than whites for 73 percent of the core measures included in the disparities report. Hispanics received poorer quality of care than non-Hispanic whites for 77 percent of the measures. Poor people received lower quality of care than high-income people for 71 percent of the measures.

Both reports are available online at and

Print copies of the NHDR (AHRQ Publication No. 07-0012) and the NHQR (AHRQ Publication No. 07-0013) are also available from the AHRQ Publications Clearinghouse.

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