AHRQ: U.S. healthcare quality is s-l-o-w-l-y improving
According to the 2009 National Healthcare Quality Report by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Health and Human Services (HHS), the quality of healthcare is improving, but slowly, especially in the areas of preventive care and chronic disease management.

The report, which has been issued annually since 2003, sought to observe the status of healthcare quality in the U.S., where in the U.S. healthcare quality improvement is most needed and how the quality of the U.S. healthcare has been progressing over time.

In addition to improving healthcare for the uninsured--who, the report notes, are less likely to obtain recommended care in areas such as preventive services and diabetes management-- the AHRQ said that subjects including patient safety and hospital-acquired infections merit urgent attention if the U.S. is to achieve higher quality healthcare in the near future.

In terms of patient safety, the authors noted “disturbing” findings. “Last year we reported that approximately one out of seven adult hospitalized Medicare patients experienced one or more adverse events. This year, we see problems specifically in the area of healthcare-associated infections…It is unfortunate that rates of healthcare-associated infections are not declining,” said the report.

When observing change over time, the authors said that while suboptimal quality of care is undesirable, rates of “vigorous improvement” would lower concern.  However, healthcare quality in some areas is still sluggish, they noted. “Care delivered in hospitals improved at an annual rate of change of almost 6 percent, which continues to be the highest rate of quality improvement among the major healthcare delivery settings. In contrast, care in outpatient settings improved at a rate that only slightly exceeded 1 percent… Similarly, improvement in preventive services and chronic disease management lagged behind improvement in acute disease treatment,” said the report.

Removing barriers to healthcare is an element that must be addressed in the coming year, the report noted, as improvement will be impeded since more than 46 million Americans are uninsured. “Lack of health insurance is a major hindrance to quality care and should be reduced,” wrote the authors, explaining that the quality of care received by patients without insurance compared with those with private insurance is consistently worse. 

“Nearly two-thirds of patients who are unable to get or delayed in getting needed care report a reason related to cost or insurance,” the report found.

Another measure to accelerate the pace of healthcare quality noted in the report was empowering providers with health IT and training. Providers need information about their performance in order to guide improvement, and health IT infrastructure is needed to ensure that relevant data are collected regularly, systematically, and unobtrusively while protecting patient privacy and confidentiality, the authors said.

Making mention to the reimbursement incentives provided by the American Recovery and Reinvestment Act (ARRA), the report suggested that providers that are adopting EHRs may see improvements in health outcomes. However, the AHRQ also stated that establishing and sustaining partnerships to facilitate change, as well as sufficient training is important, and referred to quality improvement as a “team sport.”

Geographic areas also saw variations in quality of care. “We observe wide variation across states, those in the upper Midwest and New England tend to achieve the highest overall quality of care while states in the Southwest and South Central parts of the country tend to have the lowest quality and may benefit from more urgent attention,” said the AHRQ

In offering ways to accelerate improvement of the quality of healthcare, the report said that measures need to be adapted to guide local interventions and community partnerships that bring together all the stakeholders who can “make or break” a quality improvement initiative, need to be created and maintained.

“Building on information contained in the National Healthcare Quality Report…HHS organizations are working on an exciting range of programs that seek to accelerate the pace of health care quality improvement nationwide,” concluded the AHRQ.