Wide Gaps Remain in Quality of Care, Says AHRQ

Cheryl Clark, April 14, 2010

Despite much more attention to the issue of patient safety, rates of postoperative sepsis— or bloodstream infections—increased in the U.S. by 8% between 2009 and 2008, according to one of two new lengthy reports issued by the Agency for Healthcare Research and Quality.

The first document, called the National Healthcare Quality Report, pointed out these other disturbing signs:

  • Post-operative catheter associated urinary tract infections increased by 3.6%.
  • Rates of selected infections due to medical care increased by 1.6%
  • There has been no decline, but also no increase, in the number of bloodstream infections associated with central venous catheter placements.
  • Rates of postoperative pneumonia declined by 12%.

"It is unfortunate that hospital acquired infections are not declining," according to the quality report. "Of all the measures in the NHQR . . . the one worsening at the fastest rate is postoperative sepsis."

Two process measures—techniques thought to decrease the likelihood of bloodstream infections—are improving steadily. But outcome measures—the number of actual infections—are lagging, the report said.

The second of the documents, entitled National Healthcare Disparities Report, reported that non-white U.S. residents are still less likely than whites to receive preventive antibiotics before surgery in a timely manner.

Other findings include:

  • Obese adults who are black, Hispanic, poor or have less than a high school education are less likely to receive diet advice from their doctor.
  • Most overweight children and one-third of obese adults report that they have not been told by their doctor that they are overweight.
  • Most American children have never received counseling from their healthcare provider about exercise, and almost half have never received counseling about healthy eating.

"Despite promising improvements in a few areas of healthcare, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access," said AHRQ Director Carolyn Clancy, MD. "Targeted AHRQ-funded research in Michigan has shown that infection rates of hospital-acquired infections can be radically reduced. We are now working to make sure that happens in all hospitals."

Secretary of Health and Human Services, Kathleen Sebelius said the two reports show the need for health reform. "In 2009, healthcare associated infections increased and minorities were less likely to have insurance and less likely to get the treatments they needed. In a reformed system, more Americans will get the care they need, regardless of their race or ethnicity, and the quality of care will improve.

"The numbers we saw today are troubling, but ultimately, reform will help turn these numbers around."

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