U.S. quality improvement steady, but progress on disparities elusive

The biggest jumps in performance come on measures of acute care quality, according to two new reports compiling federal data.

By Kevin B. O’Reilly — Posted March 14, 2011

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The U.S. health system is demonstrating better performance on most of the federal government's 179 measures of health care quality, but it's failing to improve access to care or cut racial and ethnic health disparities, according to two reports released in February by the Agency for Healthcare Research and Quality.

American health care improved its performance on two-thirds of quality measures in areas such as acute care, delivery of preventive services and chronic disease management, with a median annual rate of improvement of 2.3% on a composite measure, according to the "2010 National Healthcare Quality Report."

But there was improvement on only 40% of the 22 measures of access to care, such as the number of people younger than 65 with health insurance. The median rate of improvement on these metrics is negative 0.6% a year, said the report, which tracks performance from 2000 to 2008 and is compiled on an annual basis. The picture on disparities also is grim, with fewer than 20% of the measures of racial and ethnic care gaps narrowing, said the "2010 National Healthcare Disparities Report."

"Quality of care continues to improve, but at a slow rate," said Ernest Moy, MD, leader of the team at AHRQ that produced the reports. "In contrast to that, focusing on issues of access to care, not much has changed. Focusing on disparities in care, not much changed. ... Those are bigger problem areas than overall quality of care."

Measures related to hospital quality are showing the most improvement. For example, in 2005, just 42% of patients with ST-segment elevation myocardial infarction received angioplasties within the recommended 90 minutes of arriving at the hospital. That figure improved to 81% by 2008.

"The hospitals control the situation," Dr. Moy said. "They don't have to depend on patients to do something, so these measures are amenable to very rapid change. The other areas that tend to be slower in improving -- getting people to get preventive services, managing chronic diseases -- then the outcomes tend to develop more slowly or we need to do something different for those areas."

The congressionally mandated 200-plus page reports, released annually since 2003, were reorganized this year along lines recommended by an Institute of Medicine panel to focus on key areas such as population health, patient safety, palliative care and overuse of services. The report divides states into quartiles by the number of measures for which the state ranked in the top 10%.

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External links

2010 national health care quality and disparities reports, Agency for Healthcare Research & Quality, February (link)

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