| AHRQ Finds Modest Healthcare Quality Gains Outpaced By Spending
The quality of healthcare 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 by the Agency for Healthcare
Research and Quality (AHRQ).
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 healthcare spending. The Centers for Medicare
and Medicaid Services estimate healthcare expenditures rose by a 6.7
percent average annual rate over the same period, AHRQ said.
Each year, AHRQ’s companion Quality and
Disparities reports update national trends in the delivery of
healthcare. 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, AHRQ said.
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, AHRQ said.
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 said.
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, according to AHRQ.
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 healthcare 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.
Address: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850; (301) 427-1364, www.ahrq.gov.
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