Patient Safety Measures and Safety Culture Improving, but Gaps Remain

ahrq-sqBy Richard Kronick, Ph.D.
Twitter: @AHRQNews

The health care industry wasn’t an early adopter of the well-known mantra that “you can’t manage what you can’t measure.” But measuring and reporting performance on indicators of patient safety and quality have contributed to some marked improvements in recent years, according to the newly released 2014 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (AHRQ). Released with the report is a new Chartbook on Patient Safety that summarizes trends across key patient safety measures, offers downloadable slides, and includes a data query tool with access to all data tables.

On a national level, the safety and quality of health care is improving, especially for care delivered in hospital settings and for measures that are publicly reported to the Centers for Medicare & Medicaid Services (CMS). 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 3 years (2011, 2012, and 2013). One potentially deadly type of hospital-acquired infection, central line-associated bloodstream infections for medical and surgical patients, declined at an average annual rate of more than 10 percent per year.

Despite these dramatic improvements, 121 adverse events per 1,000 hospitalizations occurred in 2013, and rates of post-operative acute kidney injury or complication of diabetes worsened over the 2000 to 2012 period.

Notwithstanding the progress that has been made, there is much work to do to assure that health care doesn’t harm patients.

Quality of care measures that are publicly reported to CMS’ Hospital Compare Web site show continued improvement. Several measures dealing with recommended care for hospital patients with pneumonia and heart conditions have achieved an overall performance level of 95 percent, the report found. Because further opportunities for improvement are limited at this level of performance, these measures will not be tracked in future reports.

Quality, while improving, remains far from optimal. Across a broad array of measures, recommended care is delivered only 70 percent of the time, according to the report. Only half (52 percent) of patients with hypertension have it controlled, while 76 percent of adults are regularly screened for high cholesterol.

Major disparities also persist in quality and safety of care, the report found. For about one-third of the patient safety measures tracked in the report, people in poor households received worse care than people in high-income households, and Blacks and Asians received worse care than Whites.

Although patient safety initiatives typically focus on inpatient hospital events, adverse events also occur in outpatient settings. One such measure, which tracks the rate of potentially inappropriate prescription medications among adults age 65 and older, found overall improvement. Between 2002 and 2012, the percentage of adults who received potentially inappropriate prescription drugs decreased overall for all racial and ethnic groups and for all income groups. Poor adults had the largest percentage decrease, from 23 percent in 2002 to 11 percent in 2012.

Improving patient safety begins with being aware of your organization’s culture. Results from AHRQ’s 2014 Hospital Survey of Patient Safety Culture found that seven of 12 composite measures (teamwork within units, organizational learning, management support for patient safety, feedback and communication about error, frequency of events reported, teamwork across units, and handoffs and transitions) had higher positive responses than in 2012. One composite measure, staffing, received a lower positive response in 2014 than in 2012.

AHRQ’s National Quality and Disparities Report and Patient Safety Chartbook provide detailed evidence of the progress that has been made and the work that remains 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. Continued concerted efforts are needed to sustain progress toward these goals.

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.