Report: Little improvement in healthcare quality measures in 2008

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A decade of improvement in the quality of healthcare provided in the United States came to a halt in 2008, according to a report issued last week by the National Committee for Quality Assurance (NCQA).

According to the NCQA report, the quality of U.S. healthcare in 2008 was “virtually stagnant,” a trend seen across the board, no matter whether it was care provided to people with private health insurance coverage or people on Medicaid or Medicare.

The report examined data submitted by 979 U.S. health plans—covering 116 million Americans. The data were submitted using NCQA’s Healthcare Effectiveness Data and Information Set, which assesses how often patients receive care that conforms to evidence-based guidelines.

In the report, NCQA estimated that if all health plans performed to the level of those plans in the top 10 percent, the United States would avoid up to 115,000 thousand deaths and save at least $12 billion in medical costs and lost productivity every year.

Instead, the NCQA found that there continued to be declines in measures related to several areas of care, including mental health, diabetes, the overuse of imaging for low back pain and breast cancer screening. The report found that several areas of care have seen little progress over the last several years, including:

  • Only 46.4 percent of people taking anti-depressant drugs are monitored by their physicians;
  • 34.1 percent of children prescribed medications for attention deficit hyperactivity disorder are seeing a doctor for follow-up care;
  • Half of patients previously hospitalized for mental illness see a physician for a follow-up visit;
  • 45.3 percent of people are receiving colon cancer screening at the appropriate age; and
  • Only 42.6 percent of patients with alcohol or drug dependency are entering into treatment.

A survey of measures concerning Medicare and Medicaid patients indicated that the quality of care for some of the most vulnerable U.S. citizens has failed to improve.

According to the report, for the third year in a row those health plans serving Medicare and Medicaid patients “failed to appreciably improve on key quality measures.” Among Medicare Advantage plans, only 5 of 36 measures showed any significant improvement, while for Medicaid, only 18 of 50 measures showed any statistically significant gain.

There were some improvements in care noted. For example, the NCQA reported a:

  • 12 percent jump in the provision of beta-blocker drugs to Medicare patients, who had a heart attack within the previous six months;
  • Near universal high-quality care for the estimated 30 million Americans with asthma; and
  • Substantial gains in helping Medicaid beneficiaries stop smoking.

As for who benefits from improvements in healthcare, the NCQQ determined that geography had much to do with who receives quality care and who doesn’t.  Across measures relating to diabetes, cancer screening, behavioral health and cardiovascular care, high-performing regions outperformed low ones by 14 percent or more.

New England health plans continued to outperform other regions, while the quality of care in the South Central region of the U.S. (Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana and Texas) tended to lag behind. For example, New England health plans were 16.3 percent more likely to treat diabetics according to accepted guidelines and 19.2 percent more like to ensure that patients received all appropriate cancer screenings, compared with health plans in the South Central region of the United States.