AHRQ – Quality and Disparities: Missed Opportunities for Quality Improvement
May / June 2007
AHRQ
Quality and Disparities: Missed Opportunities for Quality Improvement
Despite focused, collaborative national and regional efforts to improve the quality of healthcare delivered in the United States, the number of patients who do not receive appropriate treatment remains high. In fact, for certain services, recommended care is delivered only about half the time.
The healthcare community strives to understand these variances — both their nature and their reasons. Every year, millions of patients in the United States receive healthcare from highly committed and compassionate physicians and nurses. This care is often provided in sophisticated hospitals boasting the latest advances in clinical technology, or in other care settings that are suitable to the patient’s needs. And, in fact, overall quality is improving, as the recently published 2006 National Healthcare Quality Report and National Healthcare Disparities Report demonstrate.
Even so, the evidence is clear that much more can be done to prevent illness from occurring or progressing. The gap between what should be done and what frequently is done presents a series of missed opportunities. Understanding and addressing these missed opportunities — by reducing variability and improving quality for all — should be our nation’s highest healthcare priority.
The Data Show Improvement
The quality report, published by the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) and presented to Congress in January 2007, tracks quality measures for the healthcare system, such as what proportion of heart attack patients receive recommended care when they arrive at a hospital. Its companion, the disparities report, summarizes which racial, ethnic, and income groups are most likely to benefit from improvements in healthcare. The two reports — the fourth annual reports — are published together because it is important to track overall healthcare quality improvement simultaneously with the disparities that continue to plague our healthcare system.
The quality report demonstrates that, despite some disturbing trends, the quality of American healthcare as measured is improving. Most measures of quality continue to show consistent improvement. For example:
- Of the 40 core report measures with trend data, 26 showed significant improvement, 2 showed significant deterioration, and 12 showed no change.
- The median annual rate of change for the core measures is a 3.1% improvement.
It is noteworthy that for 3 consecutive report years, this rate of improvement has remained constant.
Even more heartening, areas in which there have been intensive national efforts to improve the quality of care have seen very significant quality improvements: hospital care for heart attack patients improved 15%, and hospital care for pneumonia patients improved 11.7%. I believe these improvements are directly attributable to initiatives sponsored by the Department of Health and Human Services’ Centers for Medicare and Medicaid Services, which has worked with Hospital Quality Alliance and other stakeholders to foster appropriate and timely care and provide quality measurement information to consumers.
Yet, providers are still missing important opportunities to help Americans avoid disease or serious complications. Of particular concern, the use of proven prevention strategies lags significantly behind other gains in healthcare. These include:
- Only about 52% of adults reported receiving recommended colorectal cancer screenings.
- Fewer than half of obese adults reported being counseled about diet by a healthcare professional.
- Only 49% of people with asthma said they were told how to change their environment.
- Only 48% of adults with diabetes received all three recommended screenings to prevent disease complications.
As the National Healthcare Disparities Report reveals, access to and quality of care varies widely among racial, ethnic, and economic groups. Unfortunately, minority populations tend to receive poorer quality care. For the core measures included in the disparities report, blacks received poorer quality care than whites on 73% of the measures; Hispanics received poorer quality care than non-Hispanic whites for 77% of the measures; and low-income people received lower quality care than high-income people for 71% of these measures.
Opportunities Seized and Missed
The AHRQ reports characterize two major healthcare public policy challenges: to improve the quality of healthcare and to make sure that no communities or populations are left behind in our quality improvement efforts.
The reports’ comprehensive data also suggest that at all levels, including state and national levels, quality improvement works. Sustained focus, public reporting, and active and persistent interventions make a significant difference in the quality of healthcare, especially in the areas of patient safety and in hospital processes. The data from these reports lead us to conclude that healthcare quality improvement is not only possible but is, in fact, inevitable if it is the subject of a serious, rigorous, and persistent improvement effort. If our approach to quality improvement is haphazard or lacks vision, however, certain areas of healthcare quality will suffer and patients will be harmed as a result.
Finally, these reports give us direction as to where we should aim our quality efforts, and the trends tracked over the last 4 years of reports give us a tracking system to see how we are doing. A focus on preventive services would benefit all patients, particularly minority patients: African-Americans are more likely to experience insufficient preventive services for colorectal cancer, children’s vaccinations, and pneumonia vaccinations for the elderly; and Hispanic women are less likely than non-Hispanic white women to seek prenatal care during the first 3 months of pregnancy. These are disparities that should, and can, be addressed.
Each healthcare encounter, be it a physician’s office visit, a hospital admission, or a visit from a home healthcare aide, represents an opportunity to deliver the care that meets accepted quality thresholds (i.e., care that is safe, timely, efficient, equitable, effective, and patient-centered). Each encounter that fails to meet these thresholds is an opportunity missed.
In the ensuing months, AHRQ will be releasing a new Web version of the NHQR and NHDR that will enable users/stakeholders to create customized reports from the data tables and learn about and improve their particular area of interest. In addition, AHRQ will be releasing state-by-state data in its State Snapshots that will put the focus on what can be done locally to create positive change.
The hundreds of millions of annual healthcare encounters comprise one large opportunity — to improve the overall quality of healthcare across the board. In a related effort to improve those encounters, AHRQ also has joined with The Advertising Council to launch a national public service advertising campaign designed to encourage adults to take a more proactive role in their healthcare. The new “Questions Are the Answer: Get More Involved With Your Health Care” aims to encourage all patients and caregivers to become more active in their healthcare by asking questions.
The campaign includes new television, radio, print, and Web advertising that directs audiences to call a toll-free number (1-800-931-AHRQ) and visit a comprehensive Web site (www.ahrq.gov/questionsaretheanswer) to obtain tips on how to help prevent medical mistakes and become a partner in their healthcare. The site also features an interactive “Question Builder” that allows consumers to generate a customized list of questions for their healthcare providers that they can bring to each medical appointment.
The healthcare quality improvement movement has matured this decade, but still remains in its infancy. We need to continue to study quality shortcomings and disparities, and to allow the data to drive our quality improvement efforts.
Carolyn Clancy is director of the Agency for Healthcare Research and Quality. She may be contacted at cclancy@ahrq.gov.