Research Activities, April 2011: Feature Story: Health care quality still improving slowly, but disparities and gaps in access to care persist

Feature Story
Health care quality still improving slowly, but disparities and gaps in access to care persist

Improvements in health care quality continue to progress at a slow rate—about 2.3 percent a year. However, disparities based on race and ethnicity, socioeconomic status, and other factors persist at unacceptably high levels, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report released by the Agency for Healthcare Research and Quality (AHRQ) of the Department of Health and Human Services.

The reports, which are mandated by Congress, show 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 several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.

"All Americans should have access to high-quality, appropriate, and safe health care that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal," said AHRQ Director Carolyn M. Clancy, M.D. "We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement."

Gains in health care quality were seen in a number of areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42 percent in 2005 to 81 percent in 2008. Other very modest gains were seen in rates of screening for preventive services and child and adult immunization. However, measures of lifestyle modifications such as preventing or reducing obesity, smoking cessation, and substance abuse saw no improvement.

The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians, and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures.

Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one showed a reduction—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care.

Each year since 2003, AHRQ has reported on the progress and opportunities for improving health care quality and reducing health care disparities. The National Healthcare Quality Report focuses on national trends in the quality of health care provided to the American people, while the National Healthcare Disparities Report focuses on prevailing disparities in health care delivery as it relates to racial and socioeconomic factors in priority populations.

The Quality and Disparities Reports are available online at
http://www.ahrq.gov/qual/qrdr10.htm, by calling 1-800-358-9295, or by sending an E-mail to ahrqpubs@ahrq.hhs.gov.


Research Activities, April 2011: Feature Story: Health care quality still improving slowly, but disparities and gaps in access to care persist