By Richard Kronick, Ph.D.
Today, more Americans than before get safer care, more effective treatments for their illnesses, and better access to care, a new report from AHRQ finds. The 2014 National Quality and Disparities Report provides clear evidence that long-standing efforts to make our health care system better, including enactment of the Affordable Care Act, are making a difference.
While welcome news, quality is still far from optimal, and the benefits aren’t shared by everyone.
Patient safety showed sustained improvement, particularly in the hospital setting. As reported by AHRQ in a December 2014 report, hospital care was safer in 2013 than in 2010, with 17 percent fewer harms to patients and an estimated 1.3 million fewer hospital-acquired conditions, 50,000 fewer deaths, and $12 billion in cost savings over three years (2011, 2012, and 2013). This is a remarkable improvement in safety and clearly represents great progress. However, in 2013 there were still 121 adverse events per 1,000 hospitalizations. Much more work is needed to lower that rate.
Measures tracking quality of care in the report improved overall. Quality of care measures publicly reported by the Centers for Medicare & Medicaid Services on its Hospital Compare website show continual improvement. In fact, several measures dealing with recommended care for hospital patients with pneumonia and heart conditions have achieved an overall performance level of 95 percent. Further opportunities for improvement are limited at this level of performance, so these measures will not be tracked in future reports.
However, on many dimensions, quality remains far from optimal. For example, only 76 percent of adults are regularly screened for high cholesterol and only 52 percent of patients with hypertension have it controlled. Across a broad array of measures, recommended care is delivered only 70 percent of the time.
And we still have substantial disparities in care—for many measures, lower income people and members of racial and ethnic minorities receive poorer quality care and have poorer outcomes than people with more income and non-Hispanic whites. Among adult current smokers who had a medical checkup in the past year, blacks were less likely than whites to receive advice about quitting smoking. And low-income adults were less likely than high-income adults to undergo a routine hemoglobin A1c test each year to determine if their diabetes was under control.
While our work to eliminate disparities in care has far to go, some measures showed vast improvement. Adolescent vaccination rates improved by more than a 10 percent annual rate, and disparities in vaccination rates were eliminated for blacks (measles-mumps-rubella), Asians (influenza), American Indians and Alaska Natives (hepatitis B), and people in poor households (human papillomavirus).
Substantial progress has been made in reducing disparities in health insurance as a result of the Affordable Care Act coverage expansions (PDF File, 858.73 KB). More than 16 million people have gained insurance as a result of the coverage expansions, and the gains have been greatest among blacks and Hispanics.
The Quality and Disparities Report reminds us that we still have work to do to create a health system that promotes the National Quality Strategy’s priorities of patient safety, person-centered care, care coordination, effective treatment, healthy living, and affordable care. As a nation, we can take pride in accomplishments over the past few years as we continue our efforts to achieve better care, smarter spending, and healthier people through incentives, information, and how care is delivered.
About the Author: Richard Kronick, Ph.D., is Director of the Agency for Healthcare Research and Quality. This article was originally published on AHRQ Views Blog and is republished here with permission.