Hospitals are leading the movement to improve the quality of care delivered to U.S. patients, outpacing improvements in other settings, according to two national reports issued today by the Agency for Healthcare Research and Quality (AHRQ). Three-quarters of hospital quality measures showed significant improvement, compared with 60 percent for home health and nursing home care, and about half for ambulatory settings.
The U.S. Department of Health and Human Services (HHS) Partnership for Patients initiative, HHS' Centers for Medicare & Medicaid Services (CMS) quality reporting programs, such as the Hospital Inpatient Quality Reporting Program and Hospital Outpatient Quality Reporting Program, and private-sector initiatives such as those sponsored by the Institute for Healthcare Improvement have been catalysts for the current quality improvement effort in hospitals.
"Hospitals are clearly engaged in efforts to improve health care quality in the United States," said AHRQ Director Richard Kronick, Ph.D. "The intense national focus on quality improvement in hospitals is starting to pay off, but much work remains to make sure that all Americans have access to high-quality care in every setting."
The 2013 National Healthcare Quality Report and National Healthcare Disparities Reportshow that Americans are receiving recommended medical services 70 percent of the time. The reports include data based on hundreds of health care measures categorized in several areas of quality. These are effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure and access. This marks the 11th year AHRQ has reported on the state of national health care quality and disparities.
The reports also indicate that public reporting of quality measures through venues such as CMS' Hospital Compare website may have contributed to improvements. Fourteen of the 16 quality measures that reached a 95 percent performance level were publicly reported by CMS. Another four CMS measures are among those improving at the fastest pace. Every CMS measure tracked in the reports and publicly reported on the Hospital Compare Web site showed improvement over time, compared with 60 percent of hospital measures that are not publicly reported by CMS.
Consistent with other national reports—including a CMS report released May 7 —rates of some healthcare-associated infections, or HAIs, are beginning to fall while processes to prevent hospital readmission are improving. Quality also has improved for measures on adolescent vaccination, HIV treatment, colon cancer surgical care and hospital care for patients with heart problems and pneumonia. Quality worsened for measures on diabetes checkups, Pap smears, maternal deaths at delivery and preventive care for patients with asthma.
The reports include trend data for most measures of quality and disparities from 2000-2002 to 2010-2011, which predate implementation of most of the Medicaid expansions and health insurance exchanges under the Affordable Care Act. The reports provide a baseline for tracking progress under the Affordable Care Act in upcoming years.
The reports also found deficiencies regarding health care access, with 26 percent of Americans (especially racial and ethnic minorities and low-income people) reporting difficulties getting care. Most disparities in quality of care that were related to race, ethnicity or income showed no significant change. However, for blacks, Hispanics, Asians and poor people, the number of disparities showing improvement was larger than the number of disparities that were getting worse.
Each year since 2003, AHRQ has reported on the progress and opportunities for improving health care quality and reducing health care disparities. The National Healthcare Quality Report focuses on national trends in the quality of health care provided to the American people, while the National Healthcare Disparities Report focuses on prevailing disparities in health care delivery as they relate to racial and socioeconomic factors in priority populations.
The quality and disparities reports are available online at NHQRnet, a website that has been redesigned to facilitate benchmarking and trending capabilities. It includes a data query tool to compare national- and state-level data. Printed copies of the reports can be obtained by calling 1-800-358-9295 or by sending an e-mail to email@example.com.
AHRQ is a research agency within HHS. Its mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with HHS and other partners to make sure that the evidence is understood and used.
For more information, visit www.ahrq.gov.