Missed Opportunities for Prevention: Overview of Findings from the 2006 National Healthcare Quality Report

Background/Design: The National Healthcare Quality Report (NHQR) is an annual snapshot of the quality of the U. S. health care system. The NHQR continues to be the broadest analysis of the quality of healthcare undertaken in the U.S. and aims to help policymakers, government program managers, employers, health care executives and insurers determine how to prioritize, plan and implement advances in health care delivery. The report tracks the health care system through 211 quality measures, including 40 core measures. These represent performance in four key areas: effectiveness of care, patient safety, timeliness, and patient centeredness. The report also analyzes quality and access to care by clinical conditions, including cancer, diabetes, end-stage renal disease, heart disease, and respiratory diseases; and for nursing home and home health care. Principal Findings: The 2006 NHQR shows the U.S. health care system is missing important chances to help Americans avoid disease or serious complications. The report documents missed opportunities in colorectal cancer screenings, obesity counseling, asthma management, screenings for diabetes complications, pneumonia vaccines for the elderly and other areas. Overall, meanwhile, the quality of care of the U.S. health care system continues to improve at about 3 percent a year. The greatest gains in the 2006 reports were seen in hospitals, which improved by 7.8 percent. The quality of care of ambulatory services improved by 3.2 percent. Examples of specific findings from the 2006 NHQR include: Only 58 percent of obese adults reported being counseled about exercise. Only 37 percent of overweight children and teens ages 2-19 reportedly are told they are overweight by a health care professional. Conclusions: Four themes emerged from the 2006 NHQR: (1) Most measures of quality are improving, but the pace of change remains modest. (2) Quality improvement varies by setting and phase of care. (3) The rate of improvement accelerated for some measures while a few continued to show deterioration. (4) Variation in health care quality remains high. Findings in the 2006 NHQR report suggest that ongoing emphasis on the delivery of clinical preventive services and also the use of care management plans for high morbidity conditions like asthma and diabetes are key areas for further improvements in quality. Given that most of these services are delivered in the ambulatory setting, collaborative efforts such as the Ambulatory Care Quality Alliance are well-positioned to support quality improvement.