Health care quality showing slow improvement

Hospitals advance more quickly on quality than physician practices, a new report says. Patient safety and health disparities show less progress.

By Kevin B. O’Reilly — Posted May 27, 2009

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Twin government reports released in May that track the American health system's performance show that quality of care has improved at a dilatory 1.4% pace, while markers of racial and ethnic health disparities have stagnated.

"The progress of quality is incredibly slow, and disparities are persisting," said Ernest Moy, MD, PhD, who directs the team at the U.S. Agency for Healthcare Research and Quality that produces the companion reports on health care quality and disparities (link).

The reports, published annually since 2003, assemble data on more than 220 measures of quality, patient safety and cost-efficiency. The most recent data available vary by measure, making it difficult to say how the health system fared in 2008 versus 2007. But some trends are becoming clear, Dr. Moy said.

"There are differences in the rate of improvement, and what we see is more rapid improvement in the hospital measures and acute treatment measures, and much slower rates of improvement in chronic care and chronic disease management," he said.

Since the first quality report, hospitals have improved their performance on quality measures by 2.8% annually, while ambulatory care has advanced at a 1.1% clip. Dr. Moy speculated that making quality reporting a condition of full Medicare reimbursement has spurred hospitals to pay closer attention to their performance and undertake initiatives to improve.

Meanwhile, fewer than half of the 38 metrics tracking patient safety showed improvement. Safety is the only area to show an annual decline -- 0.9% -- since 2003, largely driven by the challenge of health care-associated infections.

At least 60% of the measures of disparities -- how care that blacks, Asians, American Indians, Alaskan Natives, Hispanics and poor people receive compares with that received by whites and the affluent -- either stagnated or worsened from 2000 to 2006. There are consistent disparities across minority groups in colorectal cancer screening, patient-centered care and mental health treatment.

Upon issuing the reports, Health and Human Services Secretary Kathleen Sebelius announced that $50 million in stimulus package spending would go to help doctors and hospitals battle infections and improve patient safety.

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