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Healthcare quality gains outpaced by spending

Newswise — The quality of health care improved by an average 2.3 percent a year between 1994 and 2005, a rate that reflects some important advances but points to an overall slowing in quality gains, according to annual reports released today by the Agency for Healthcare Research and Quality.

The improvement rate, reported in AHRQ’s 2007 National Healthcare Quality Report and National Healthcare Disparities Report, is lower than the 3.1 percent average annual improvement rate reported in the 2006 reports. Those reports measured trends between 1994 and 2004.

Quality improvement rates are lower than widely documented increases in health care spending. The Centers for Medicare & Medicaid Services estimate health care expenditures rose by a 6.7 percent average annual rate over the same period.

“Health care quality is improving only modestly, at best,” said AHRQ Director Carolyn M. Clancy, M.D. “Given that health care spending is rising much faster, these findings about quality underscore the urgency to improve the value Americans are getting for their health care dollars.”

Each year, AHRQ’s companion Quality and Disparities reports update national trends in the delivery of health care. The analyses measure quality and disparities in four areas: effectiveness of care, patient safety, timeliness of care and patient centeredness.

The 2007 reports – the 5th edition since the reports’ inaugural release in 2003 – show some notable gains, such as improvements in the care of heart disease patients. When measuring what portion of heart attack patients received recommended tests, medications or counseling to quit smoking, the reports found an average 5.6 percent annual improvement rate from 2002 to 2005.

Measures of patient safety, meanwhile, showed an average annual improvement of just 1 percent. That modest improvement rate reflected such measures as what portion of elderly patients had been given potentially harmful prescription drugs and how many patients developed post-surgery complications.

The reports also showed some reductions in disparities of care according to race, ethnicity and income. For example, while Hispanics remain more likely than whites to get delayed care or no care at all for an illness, that disparity decreased between 2000/2001 and 2004/2005. In addition, while black children between 19 and 35 months old remain less likely than white children to receive all recommended vaccines, that disparity also decreased.

Overall, however, many of the largest disparities remain. Black children under 18 are 3.8 times more likely than white children to be hospitalized for asthma. New AIDS cases are 3.5 times more likely among Hispanics than whites. Among pregnant women, American Indians or Alaska natives are 2.1 times less likely to receive first trimester prenatal care.

AHRQ’s Quality and Disparities Reports, which are mandated by Congress, are read widely by policymakers, health care analysts, public health advocates, health insurers, journalists and consumers. This year’s National Healthcare Quality Report synthesizes more than 200 “quality measures,” which range from how many pregnant women received prenatal care to what portion of nursing home residents were controlled by physical restraints. The National Healthcare Disparities Report, meanwhile, summarizes which racial, ethnic or income groups are benefiting from improvements in care.

The 2007 reports draw on data from more than three dozen databases, most sponsored by federal health agencies. Among the findings:

· More than 93 percent of heart attack patients received the recommended hospital care in 2005, up from about 77 percent in 2000/2001. The percent of heart attack patients who were counseled to quit smoking increased from about 43 percent in 2000/2001 to about 91 percent in 2005.

· A lack of health insurance may have significant impacts on health care quality. For example, only 18 percent of people without insurance went to the dentist at least once in the previous year compared with 51 percent with private insurance. Only 38 percent of uninsured women received mammograms in the past two years compared with 74 percent with private insurance.

· About 26 percent of adults with basic disabilities – those disabilities that challenge mobility or other basic functions – received delayed care or no care at all compared with about 11 percent of people without disabilities. About 23 percent of seniors with disabilities took inappropriate medications compared with 13 percent of seniors without disabilities.

· Among people who needed treatment for illicit drug use in 2005, only 18 percent of adults between the ages of 18 and 44 actually got treatment. Only 11 percent of children between 12 and 17 got treatment. These rates have remained about the same since 2002.

The Quality and Disparities Reports are available online at http://www.ahrq.gov/qual/qrdr07.htm, by calling 1-800-358-9295, or by sending an e-mail to ahrqpubs@ahrq.hhs.gov. The quality report serves as the basis for AHRQ’s upcoming State Snapshots, which come out each spring and detail how health care quality trends vary from state to state.