Healthcare Quality Shows Slow Improvement

Healthcare quality continues to progress, albeit slowly—about 2.3% a year. Disparities based on race, ethnicity, socioeconomic status and other factors, however, remain unacceptably high, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued this week by the Department of Health & Human Services' Agency for Healthcare Research and Quality.

The reports, mandated by Congress, are based on more than 200 healthcare measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.

"All Americans should have access to high-quality, appropriate and safe healthcare that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal," said AHRQ Director Carolyn M. Clancy, MD. "We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement."

Healthcare quality gains were seen in several areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42% in 2005 to 81% in 2008. Very modest gains were seen in rates of screening for preventive services and child and adult immunization.

Measures of lifestyle modifications such as reducing obesity, smoking cessation and substance abuse saw no improvement.

The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40% of core measures. Asians received worse care than whites for about 20% of core measures. Hispanics received worse care than whites for about 60% of core measures. Poor people received worse care than high-income people for about 80% of core measures.

Of the 22 measures of access to healthcare services tracked in the reports, about 60% did not show improvement, and 40% worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3% of people saying they were unable to get or had to delay getting prescription medications to 60% of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.