AHRQs national healthcare quality and disparities reports: an ever-expanding road map for improvement

Health Services Research, June, 2007 by Jeffrey Brady, Karen Ho, Edward Kelley, Carolyn M. Clancy

In my April 2006 AHRQ Update (Clancy 2006) I discussed enhancements to the National Healthcare Quality Report (NHQR 2006) and the National Healthcare Disparities Report (NHDR 2006), annual reports produced by the Agency for Healthcare Research and Quality (AHRQ).

In this issue, my colleagues and I would like to continue our conversation with you about these reports which have become vitally important tools in our efforts to eliminate heath care disparities and improve the quality of health care services. Since I last wrote about them in this journal, we have an additional year of trend data for many of the measures included in the reports, and we released a new website which provides quality, and some disparities data by state, and we are poised to release a new online resource that will make national health care quality and disparities data even more accessible.

For those of you who are new to these reports, a little background: the NHQR and NHDR are congressionally mandated reports that have been produced by AHRQ since 2003. The latest versions were presented to Congress in January 2007. The quality report, examines the quality of health care system, as indicated by quality measures such as the proportion of heart attack patients who receive recommended care when they arrive at a hospital. Its companion, the disparities report, summarizes the same information according to various racial, ethnic, and income groups that are most likely to benefit from improvements in health care. The two reports--the fourth annual reports--are published together because it is important to consider overall health care quality improvement in conjunction with the disparities that continue to plague our health care system.

PREVENTION MESSAGE

When the reports were conveyed to Congress and publicly released, AHRQ's press materials emphasized some critical public health messages. The reports clearly demonstrated that providers continue to miss important opportunities to help Americans avoid disease or serious complications. Of particular concern, the use of proven prevention strategies lags significantly behind other gains in health care. These include:

* Only about 52 percent of adults reported receiving recommended colorectal cancer screenings.

* Fewer than half of obese adults reported being counseled about diet by a health care professional.

* Only 49 percent of people with asthma said they were told how to change their environment.

* Only 48 percent of adults with diabetes received all three recommended screenings to prevent disease complications.

According to the NHDR, access to and quality of care varies widely among racial, ethnic, and economic groups. Unfortunately, minority populations tend to receive poorer quality care. For the core measures included in the disparities report, blacks received poorer quality care than whites on 73 percent of the measures; Hispanics received poorer quality care than non-Hispanic whites for 77 percent of the measures; and low-income people received lower quality care than high-income people for 71 percent of these measures.

The AHRQ reports characterize two major health care public policy challenges--to improve the quality of health care, and to make sure that no communities or populations are left behind in our quality improvement efforts.

Based on the data presented in the reports, we know that we can improve quality at both the state and national levels--quality improvement works. Sustained focus, public reporting, and active and persistent interventions make a significant difference in the quality of health care, especially in the areas of patient safety and in hospital care processes. We can conclude that health care quality improvement is not only possible but is, in fact, inevitable if it is the subject of a serious, rigorous, persistent, and coordinated improvement effort. If our approach to quality improvement is haphazard or lacks vision, however, certain areas of health care quality will suffer and patients will be harmed as a result.

Finally, these reports give us direction for our quality efforts, and the trends tracked over the last 4 years of reports give us a gauge of our progress. A focus on preventive services would benefit all patients, particularly minority patients: African Americans are more likely to experience insufficient preventive services for colorectal cancer, children's vaccinations, and pneumonia vaccinations for the elderly; and Hispanic women are less likely than non-Hispanic white women to seek prenatal care during the first 3 months of pregnancy. These are disparities that should, and can, be addressed.

KEY THEMES

While these prevention messages are important to the nation and provide a "hook" to engage Congress and the public, the reports provide a breadth of information for health care researchers and policy makers. Each report is organized around four key themes that provide a road map to using the report for quality improvement, health care research, and decision making.