Trends in Health Care Quality: Findings from the 2010 National Healthcare Quality and Disparities Reports

Study Design: Preliminary data come from the 2010 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. Most of these are nationally representative. Measures cover the quality dimensions of effectiveness, safety, timeliness, and patient centeredness and include measures representative of care for cancer, diabetes, end stage renal disease, HIV and AIDS, heart disease, mental health, maternal and child health, nursing home and home health, respiratory disease and patient safety. 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.

Findings: Overall, measures of acute treatment are improving; measures of preventive care and chronic disease management are lagging behind. The highest rate of improvement was in measures related to treatment of acute illnesses or injuries. Of the 21 process of care measures related to acute treatment, about 80% showed improvement. In contrast, of the 35 process measures related to preventive services, only 60% showed improvement. Of the 22 process measures related to chronic disease management, about 70% showed improvement.

Some process measures that are getting worse over time.

In preventive care: - Women age 40+ who received a mammogram - Women age 18+ who received a Pap smear In acute care: - Emergency department (ED) visits lasting 6+ hours and resulting in admission to the hospital or transfer to another facility In chronic disease management: - Adults age 40+ with diabetes who received a hemoglobin A1c measurement Adults age 40+ with diabetes who received a dilated eye examination

Conclusions: Overall, cancer screening and management of patients with diabetes have worsened over time. The greatest number of measures that improved were for acute treatment measures while the lowest number of measures that improved were for preventive care. The NHQR and NHDR concentrate on tracking health care quality and disparities at the national level, but the statistics reported in the reports reflect the aggregated everyday experiences of patients and their providers across the Nation. Data from the National Healthcare Quality Report and Disparities Report inform policymakers of the progress that has been made and the opportunities for improvement.