Although the overall quality of health care delivered by U.S. providers continues to improve, use of prevention tools lags, resulting in missed opportunities to avoid certain serious diseases and their complications, according to annual reports from the Agency for Healthcare Research and Quality (AHRQ).
“Less than Optimal”
The most recent editions of the National Healthcare Quality Report and the National Healthcare Disparities Report found less than optimal participation in cancer screenings, obesity counseling, and disease management strategies by individuals with chronic conditions such as diabetes and asthma. These missed opportunities can increase health care costs and deter effective prevention and treatment of disease.
The AHRQ quality measures look at the extent to which health care providers deliver evidence-based care for specific services, as well as the outcomes of the care provided. Forty-two core measures focus on four aspects of quality — effectiveness, patient safety, timeliness and patient-centeredness — during four stages of care: Staying healthy, getting better, living with an illness or disability, and coping with the end of life.
Overall, most measures show improvement, though on a modest basis, according to the report on quality. Hospitals demonstrated most improvement, outpacing other centers of care, such as ambulatory care, nursing home care and home health care. Specifically, hospital care for heart attack patients improved 15%, for pneumonia patients almost 12%, and for avoidance of complications after surgery more than 7%.
The median rate of improvement for acute care quality measures was about twice that for preventive and chronic care quality measures. Delving further into this difference, while vaccinations for children, adolescents and the elderly showed high rates of overall improvement, the improvement rate for other preventive measures — screenings, advice and prenatal care — was low.
For example, only half of adults received recommended colorectal cancer screenings; fewer than half of obese adults reported receiving diet counseling from a health care professional; less than half of asthmatics received advice on how to change their environment and only 28% said they had received an asthma management plan; and less than half of diabetics received the screenings recommended for this disease (blood sugar tests, foot exams and eye exams) to prevent disease complications.
The second AHRQ report examined disparities related both to the quality of and access to health care among racial, ethnic and socioeconomic groups in the U.S. The measures of quality were the same used in the report discussed above, while access measures assessed how easily patients are able to get needed care and their actual use of services.
Disparities Pervade Health Care System
According to the report, disparities continue to “pervade” almost all aspects of the U.S. health care system, with racial/ethnic minorities receiving lower quality care and worse access to care on most measures, and poorer populations receiving lower quality care on most measures and worse access to care on all measures. Disparities were particularly apparent in the area of prevention. Neighborhood solutions and focused community-based projects are the keys to eliminating these disparities, the report says.