AHRQ quality report shows improvement
Slow but steady
According to the Agency for Healthcare Research and Quality, we’re getting better at delivering healthcare. The annual National Healthcare Quality Report for 2013 reports that 70% of the time, patients get the right care, and that hospitals in particular are doing better at making sure that happens. Care related to CMS-reported measures are also getting better. To be considered to be improving, the metrics have to improve more than 1% per year.
Domains of health care covered are effectiveness, safety, timeliness, patient-centeredness, care coordination, efficiency, and adequacy of health system infrastructure.
Within effectiveness, eight clinical conditions (cancer, cardiovascular disease, chronic kidney disease, diabetes, HIV and AIDS, mental health and substance abuse, musculoskeletal diseases, and respiratory diseases) and four cross-cutting services (maternal and child health, lifestyle modification, functional status preservation and rehabilitation, and supportive and palliative care) are discussed. Care delivered in doctor’s offices, health centers, emergency rooms, hospitals, nursing homes, and home health and hospice settings is examined.
The report notes that quality is improving across some measures for all demographic groups, but not all measures, and not all demographic groups.
Among the hospital-specific measures that are improving:
• hospital patients with heart failure who were given complete written discharge instructions;
• hospital patients with pneumonia who received the initial antibiotic dose consistent with current recommendations;
• postoperative physiologic and metabolic derangements per 1,000 elective surgery admissions, age 18+;
• hospital patients with heart attack who received percutaneous coronary intervention within 90 minutes of arrival;
• hospital patients age 50+ with pneumonia who received an influenza screening or vaccination.
Among those that are trending down: Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18.
Disparities in care
There are still significant disparities of care by race and ethnicity, with white people getting better care than Hispanics, African-Americans, Native Americans, and Asians, depending on the measure involved. For the two former, it was in 40% of quality measures, for the latter two, in a third and a quarter of them respectively. However, Asians receive better care than whites in about 30% of the measures.
Disparities are improving in some hospital-related areas:
• Among blacks compared to whites: Admissions for uncontrolled diabetes without complications per 100,000, age 18 and over.
• Among Asians compared with whites: Hospital patients age 65 and over with pneumonia who received a pneumococcal screening or vaccination and also adult hospital patients who sometimes or never had good communication with nurses in the hospital.
The complete report is available at http://www.ahrq.gov/research/findings/nhqrdr/nhqr13/2013nhqr.pdf.
