Research Activities, June 2010: Feature Story: Annual quality and disparities reports include data on health care-associated infections, obesity, and health insurance

Feature Story
Annual quality and disparities reports include data on health care-associated infections, obesity, and health insurance

Improvements in patient safety continue to lag, according to the 2009 National Healthcare Quality Report and National Healthcare Disparities Report released this spring by the Agency for Healthcare Research and Quality (AHRQ). Very little progress has been made on eliminating health care-associated infections (HAIs), according to a new section in the 2009 quality report. For example, of the five types of HAIs in adult patients who are tracked in the reports:

•Rates of postoperative sepsis, or bloodstream infections, swelled by 8 percent.
•Postoperative catheter-associated urinary tract infections rose by 3.6 percent.
•Rates of selected infections due to medical care increased by 1.6 percent.
•There was no change in the number of bloodstream infections associated with placement of central venous catheters, tubes placed in a large vein in the patient's neck, chest, or groin to give medication or fluids or to collect blood samples.
•However, rates of postoperative pneumonia improved by 12 percent.
•In addition, although rates are improving incrementally, blacks, Hispanics, Asians, and American Indians are less likely than whites to receive preventive antibiotics before surgery in a timely manner.
According to AHRQ Director Carolyn Clancy, M.D., AHRQ-funded research in Michigan has shown that infection rates of HAIs can be radically reduced. Over 100 participating hospital intensive care units in Michigan have been able to keep the rates of central line-associated bloodstream infections to near zero, 3 years after adopting standardized procedures. The project, conducted by the Michigan Health and Hospital Association Keystone Center, involved the use of a comprehensive unit-based safety program to reduce these potentially lethal infections.

Last year, AHRQ announced new funding that has expanded the project to all 50 States, Puerto Rico, and the District of Columbia. AHRQ's annual quality and disparities reports, which are mandated by Congress, were first published in 2003. The reports show care trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in 4 areas of quality: effectiveness, patient safety, timeliness, and patient-centeredness. The 2009 reports include a new section on lifestyle modifications, because preventing or reducing obesity is a crucial goal for many Americans and an important task for health care providers. The reports found:

•One-third of obese adults have never received advice from their doctor about exercise.
•Obese adults who are black, Hispanic, poor, or have less than a high school education are less likely to receive diet advice from their doctor.
•Most overweight children and one-third of obese adults report that they have not been told by their doctor that they are overweight.
•Most American children have never received counseling from their health care provider about exercise, and almost half have never received counseling about healthy eating.

The reports also indicate that the lack of health insurance slows improvement in health care quality and reduction of disparities. For many services, not having insurance is the single strongest predictor of poor quality care, exceeding the effects of race, ethnicity, income, or education. Americans with no insurance are much less likely then those with private insurance to obtain recommended care, especially preventive services and management for diabetes. While differences between blacks and whites in the rates of lack of insurance have narrowed in the past decade, disparities related to ethnicity, income, and education remain large.

The quality and disparities reports are available online at http://www.ahrq.gov/qual/qrdr09.htm, by calling 1-800-358-9295, or by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

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Research Activities, June 2010: Feature Story: Annual quality and disparities reports include data on health care-associated infections, obesity, and health insurance