Opportunities for Improving Quality and Disparities: Findings from the 2008 National Healthcare Quality and Disparities Reports

Study Design: Preliminary data come from the 2008 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR), which compiled national estimates on over 200 measures of health care quality from more than 35 different data sources. Trends are assessed using the geometric rate of change where the average annual rate of change is at least 1% per year and statistically significant with p<0.05. Analyses in the NHDR focus on 22 selected core measures from the full measure set and use comparisons of whites, blacks, Asians, American Indians and Alaska Natives and Hispanics. For each core measure, disparities are measured in both absolute and relative terms. Disparities for a baseline year and for the most current year of data are compared to assess trends in disparities.

Findings:

- Health care quality continues to improve at a slow pace.

- Disparities persist in health care quality and access.

In particular, data show that patient safety, colorectal cancer and mental health care are areas in health care that are in need of improvement.

- Overall, measures of patient safety showed a decline in improvement (-0.9% per year). Measures include postoperative care events such as pneumonia, UTIs, and venous thromboembolic events, appropriate timing of antibiotics, adverse events associated with central venous catheters, adverse drug events, deaths following complications of care and inappropriate medications for the elderly.

- Screening for colorectal cancer remains low. Only about 55.5% of adults age 50 and over ever received a sigmoidoscopy, colonoscopy, or proctoscopy or an FOBT (NHIS, 2005). There are also significant racial and ethnic disparities in colorectal cancer screenings. Blacks, Asians, American Indian/Alaska Natives and Hispanics were less likely than Whites to ever receive screenings.

- Mental health care is also poor. For example, nearly 30% of adults with mood, anxiety, or impulse control disorders had minimally adequate treatment (CPES, 2003). There were significant racial and ethnic and education disparities— among adults with mood, anxiety or impulse control disorders, only 9% of Hispanics, and 23% of Blacks had minimally adequate treatment, and individuals with less than high school education and high school graduates were less likely to have minimally adequate treatment.

Conclusions: Improvement in health care quality in the U.S. is slow. While there has been improvements noted in the reports, large gaps in preventive care especially for colorectal cancer, patient safety and mental health care remain.