Quality By the Numbers

In her first official appearance yesterday on Capitol Hill since her confirmation hearings, new Health and Human Services Secretary Kathleen Sebelius could have addressed a variety of topics in her opening remarks before the House Ways and Means Committee.

Maybe she could have talked about updates on the H1N1 flu or Medicare. But on this particular day, she chose to focus on the "numbers"—the numbers found in two new annual reports from the Agency for Healthcare Research and Quality on healthcare quality and healthcare disparities that were released that morning. What these numbers showed was that the country is not making much progress in achieving better quality healthcare.

Overall, she noted that the reports showed troubling findings about the status quo of the American healthcare system. "The quality report highlights that 40% of healthcare patients don't receive recommended care—and that's an ongoing situation," she told the congressional panel.

"The disparities report highlights that severe and pervasive disparities continue to persist in this county. Minority patients still receive disproportionately poor care compared to their Caucasian neighbor," she added.

For the past six years, the National Healthcare Quality Report, 2008, has had the difficult job of summarizing the state of healthcare quality. This year, it summed up the state of healthcare quality in the U.S. in one word: suboptimal.

The 160-page report noted, for instance, that only 40% patients with diabetes received the three annual exams that they need, or that one in seven Medicare patients incur an adverse event in a healthcare setting. "We can and should do better," the report states.

With the National Healthcare Disparities Report 2008, it showed that with reviewing categories of measures, quality of care and access to care, disparities exist for all population groups. And while many of these groups have access to primary and hospital care, may of individuals in minority groups lack insurance or face barriers getting everyday medical care.

The gauntlet is now down—and Sebelius appears to be up for a challenge. At the hearing, she talked specifically about central line-associated blood stream infections that strike hundreds of thousands of patients each year. But there is a "cure," she noted, by using a hospital checklist and protocol. "If implemented uniformly and on a daily basis, it dramatically reduces these results," she said.

Medicare has been studying how to reduce these infections in 10 states, and "we want to expand that protocol to all states. So as part of this effort to transform the underlying system, I'm issuing a challenge to hospitals across America to commit to using the patient safety checklist in all hospitals and reduce the serious blood stream infection in ICUs by 75% over the next three years," she said. "We want to include every hospital in every state."

And, more challenges can be expected in the future. Sebelius announced on May 6 that HHS plans to make $50 million in grants funded by the American Recovery Act available for states to help fight healthcare-associated infections, and to make $40 million available through competitive grants to eligible states to create or expand state-based HAI prevention and surveillance efforts.

So maybe at the same time in the next year—or two, maybe the numbers that we'll see associated with healthcare quality will finally show some hopeful news.