Study: Quality improving at a modest pace

Greatest gain seen in patient safety measures

The quality of U.S. health care continued to improve in 2005, according to "The 2005 National Healthcare Quality Report" from the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality (AHRQ).

Overall quality of care for all Americans improved at a rate of 2.8%, the same increase shown in last year’s report.

"That’s not the difference just for this year but the average rate of change over the last few years," explains Dwight McNeill, PhD, lead author of the report. "That’s across all 44 core measures." However, the report notes there has been much more rapid improvement in some measures, especially where there have been focused efforts to improve care.

Wide range seen

For example, the report finds a 10.2% annual improvement in the five core measures of patient safety. These are areas where coordinated national efforts are underway to improve the delivery of specific "best practice" treatments to improve patient safety and reduce medical errors. Improvements were greatest in quality measures for diabetes, heart disease, respiratory conditions, nursing home care, and maternal and child health care.

When specific measures are looked at, there is a wide range of performance, notes McNeill. "The numbers can go as low as a 10% deterioration," he observes. Low-performing measures include the suicide rate and the percentage of people who go to the ED and leave before they are treated. The latter, he says, is our worst-performing measure; it has been getting worse for a number of years."

The mental health measures were sobering, too, he continues. "We have a new measure on substance abuse and found that only 15% of people who need substance abuse care get it, and of those who get it, only 50% complete it," McNeill observes. "There continues to be a need for great improvement."

In the patient safety cluster, measures improved by as much as 40%. "But this is a low-incidence event, so it’s not too difficult to get a big bump [in a single year]," McNeill notes. "Still, our message is that since the IOM report, there’s been a lot of activity from AHRQ and other organizations to emphasize patient safety."

The hospital measures for QIO (Quality Improvement Organizations) were the second-highest group overall, at 9.4%. "This included acute myocardial infarction, heart failure, and respiratory care," says McNeill. "This is another area where Medicare and the QIOs have emphasized public reporting, and [performance has] improved. It’s another indication that if you put the spotlight on performance, it does help improvement."

While all hospital procedures have improved, says McNeill, the prevention of chronic diseases has not. This includes screening for diabetes, hypertension, cholesterol, and mammograms. "So, there’s something of a dichotomy — where there’s improvement in procedural in-hospital measures, but for the same diseases the prevention measures have not fared so well," McNeill says.

For example, he notes, there has been a tremendous reduction in heart disease measures; the mortality rate for myocardial infarctions, for example, has dropped 20% in 10 years. "But when you decompose it, the real impact on cardiac deaths is in hospital procedures — and less on prevention," McNeill says.

McNeill considers the measures in the AHRQ study to be good benchmarks. "What we are trying to do is say whether we are getting better or worse, and to what degree," he explains. "It helps people put a spotlight on problems, so they can take action to make improvements."

[The report is available by calling 1-800-358-9295, at www.qualitytools.ahrq.gov, or by sending an e-mail to ahrqpubs@ahrq.gov. You can reach Dwight McNeill at (301) 427-1734.]