Improvement in Health Care Quality Slows While Disparities Persist

The growing call among health care professionals, legislators, health policy-makers, consumer advocates, and the public to boost the overall quality of health care provided in the United States has led to advances in quality. However, according to findings from two new annual reports published by the Agency on Healthcare Research and Quality, or AHRQ, the overall rate of improvement is slowing. Similarly, although progress has been made in addressing some health care disparities among various racial, ethnic and socioeconomic groups, overall inequalities in health care among different patient populations have not improved.

The reports, which are mandated by Congress, rely on the latest available data drawn from more than three dozen databases, most sponsored by federal health agencies. These latest reports used data from 2004 and 2005, depending on the specific data source.

Between 1994 and 2005, the quality of health care improved an average of 2.3 percent each year across all core measures, according to AHRQ's 2007 National Healthcare Quality Report (144-page PDF; About PDFs). However, an analysis of selected core measures, which cover data from 2000 to 2005, shows that quality improvement has slowed to an annual rate of only 1.5 percent.

"Health care quality is improving only modestly, at best," said AHRQ Director Carolyn Clancy, M.D., in a press release about the AHRQ reports. "Given that health care spending is rising much faster, these findings about quality underscore the urgency to improve the value Americans are getting for their health care dollars."

Areas of significant improvement include care for patients who have heart attacks, the report found. More than 93 percent of these patients received recommended hospital care in 2005, up from about 77 percent in 2000-2001. In addition, more health care professionals are talking to patients who've had heart attacks about smoking; nearly 91 percent of these patients were counseled to quit smoking in 2005, up from almost 43 percent in 2000-2001.

And despite the fact that overall patient safety saw only a 1 percent improvement each year from 2002 to 2005 -- based on an assessment of factors such as the proportion of elderly patients who had been given potentially harmful prescription drugs and the number of patients who developed postsurgical complications -- areas that received significant attention saw significant advances. For example, 30 percent more patients received appropriately timed antibiotics before and after surgery in 2005 than 2004.

The report also points out several instances in which quality measures declined or remained flat, indicating "missed opportunities" for care and disease prevention, said Cmdr. Jeff Brady, M.D., M.P.H., who oversees production of AHRQ's national health care reports. Among those findings:

The 2007 National Healthcare Disparities Report (252-page PDF; About PDFs) from AHRQ found that overall inequalities in health care quality and access among different racial, ethnic and socioeconomic groups have not improved.

Progress has been made in a few areas. For example, the disparity between Asians and whites who had a usual primary care provider has been eliminated, and significant improvements in childhood vaccines have been made in most so-called priority populations.

However, compared with white patients,

Moreover, children from low-income families were more likely than those from high-income families to experience poor communication with health care professionals.

Lack of health insurance was highlighted in the AHRQ report as a major barrier to reducing health care disparities. Uninsured individuals lag behind those who have at least some private health insurance on 90 percent of quality measures and 100 percent of access measures, the report found.

"Uninsurance can lead to the lack of a usual source of health care and delayed care for necessary services," the report said. "Hispanics and blacks both report lower rates of having a usual source of care and higher rates of delaying necessary care than whites."

The uninsured are six times as likely to be without a usual source of care and three times as likely to delay care for illness or injury, the report found.