Earlier this year the Agency for Healthcare Research and Quality released its latest National Healthcare Quality and National Healthcare Disparitiesreports. But hold the cake and champagne. The opening paragraphs summarize the 457 pages of this annual, congressionally mandated pulse-taking of our U.S. health services with, "We find that health care quality in America is suboptimal," that "disparities related to race, ethnicity and socioeconomic status still pervade the American health care system," and "Americans too often do not receive care that they need or they receive care that causes harm."
"Despite promising improvements in a few areas of health care," agency Director Carolyn M. Clancy was quoted in a release, "we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access."
Lt. Karen Ho of the U.S. Public Health Service and lead staff at the agency's Center for Quality Improvement and Patient Safety, says the latest report, labeled 2009 and released in 2010, is actually data reflecting the health delivery landscape of 2007. According to Ho, the data collection process takes years, and involves a broad Health and Human Services interagency collaboration. Eighteen HHS agencies and offices "collect patient questionnaires, conduct random telephone interviews, survey claims data, review health facilities surveillance data and perform random household sampling surveys." Both the Quality and Disparity reports use the same sets of 200 measures across four dimensions: quality, effectiveness, patient safety, timeliness and patient-centredness.
The report identified insurance status across 35 core measures as a significant factor affecting both quality — services delivered, "in a way that is safe, timely, patient centered, efficient and equitable," — and disparities, "the differences or gaps in care experienced by one population compared with another population."
Uninsured individuals with chronic disease like diabetes were "less likely to get recommended care" and people with asthma "were less likely than those with private insurance to be taking preventive medicine daily or almost daily." Blacks, Hispanics, Asians and American Indians are also less likely to receive recommended care for chronic disease.
A new section addressing health and lifestyle changes was added to include measures of obesity in children and adults, and smoking cessation.
"Childhood obesity is definitely another target as it has such an impact on our population. If parents and providers don't address this at an early age, it becomes harder to address when they're older," Ho says.
However, the report finds that one-third of obese adults and most obese children overall did not receive counseling on weight loss, exercise, or how to eat healthy foods. Children from uninsured, poor, and near-poor households were significantly less likely to get information about exercise and diet from their providers compared to insured households with higher incomes. Similarly, uninsured adult smokers were also less likely to receive smoking cessation counseling.
Other disparities affect racial and ethnic groups like Asians, American Indians/Alaska Natives, Hispanics and blacks, who are experiencing an increase in colorectal cancer deaths, while both the elderly and people living in rural areas face issues in timely accessing of appropriate health services.
But gains are being made, slowly. AIDS-related deaths have fallen, the percentage of young children receiving immunization has increased, and people ages 20-39 and 40 and over had significant increases in completing a course of substance abuse treatment. Communication with doctors has also improved with patients reporting more satisfaction in encounters with their physicians during office visits.
Although a statistically significant increase in "health care-associated infections" was reported, this may be a reflection of better reporting processes of medical errors. The Patient Safety and Quality Improvement Act of 2005 provides a means for health providers and facilities to report medical error without "fear of legal discovery."
The culture of reporting mistakes is still tenuous, but Ho suggests that this new environment, and implementing recommended health information technology systems, will further better reporting and uncover areas that need change to improve quality and reduce disparities.
"The key purpose of the report is to inform policymakers, and also to inform the general public, including providers, of these issues," Ho explains, "and that is the first step working towards quality."
The next report 2010 will summarize data from 2007/08 and will be released next year.