Quality of care, patient safety see gains

The U.S. health system continues to slowly improve its performance on many measures of quality and patient safety while struggling to cut racial and ethnic disparities.

The Agency for Healthcare Research and Quality published the findings in April in companion reports on health care quality and health care disparities. The reports are based on data from 2000 to 2007 on hundreds of measures tracked by the federal government.

American health care bettered its performance on 59% of 169 quality measures, with a 2.3% annual median rate of improvement. Meanwhile, hospitals improved their performance on 52% of 33 patient safety measures.

On disparities, most gaps between whites and Asians, blacks, Hispanics and Native Americans stayed the same or got worse. But by expanding health insurance coverage to an estimated 32 million uninsured patients, the new reform law could make a significant dent in these care gaps, said Ernest Moy, MD, PhD. He directs the team that published the AHRQ reports (link).

"The research does indicate the really huge impact that uninsurance does play in worsening racial and ethnic disparities," said Dr. Moy, medical officer at the AHRQ Center for Quality Improvement and Patient Safety. "Low-income [patients] and racial minorities are much more likely to be uninsured. We look forward to documenting success on this in the future in reducing disparities."

There are huge gaps between the insured and the uninsured on measures of preventive services and diabetes management, according to AHRQ's quality report. For example, uninsured women are half as likely as women who are privately insured to have received a mammogram during the previous two years. Diabetics without insurance are 20% less likely to have had their hemoglobin A1c measured during the previous year, compared with privately insured patients with diabetes.