Prevention Health Care Quality in America: Findings From the First National Healthcare Quality and Disparities Reports

摘要

Table 1.  General Summary of Health Care in the United States, National Healthcare Quality Report and National Healthcare Disparities Report, Agency for Healthcare Research and Quality, 2003 High-quality health care is not a given inthe U.S. health care system.Thirty-seven of 57 areas with trend datapresented in the NHQR have either shown no improvement or havedeteriorated.Only 23% of individuals with hypertension haveit under control. Control of hypertension is essential tocontinued successes in reducing mortality from heart disease,stroke, and complications of diabetes.Half of the people with depression stop usingtheir medicines within the first month, far shorter than isrecommended by experts and scientific evidence.In terms of patient safety, about one in fiveelderly Americans was prescribed medications that may have beeninappropriate for them and potentially harmful.Gaps in health care quality are particularlyacute for certain racial, ethnic, and socioeconomicgroups.Blacks and Hispanics experience worse qualityof care for about half of the quality measures reported in theNHQR and NHDR.Hispanics and Asians experience worse access tocare for about two thirds of access measures.Poor people experience worse care for about twothirds of the quality and access measures.Improvement in quality and disparities ispossible.Chosen as a national priority for improvementby the Medicare QIO program, the use of beta blockers for heartattack patients rose from 21% of eligible patients in the early1990s (16) to 79%a. In addition, improvement on thismeasure has been relatively universal. Fully 45 states are at orabove 70% on this measure.A majority of women older than 40 years (70.3%) is being screened by mammography for breast cancer, exceedingthe Healthy People 2010 objective.Black women have higher screening rates forcervical cancer, perhaps related to significant investments incommunity-based cancer screening and outreach programs forcervical cancer. This data may help explain why death rates amongblack women, although still more than twice those of white women, havebeen decreasing at about twice the rate (17).Quality improvement efforts have resulted indemonstrable reductions in black/white differences in hemodialysis. A targeted intervention within a qualityimprovement culture may offer important lessons in disparityreduction. a This measure is the percentage of AMI patients that are prescribed beta blockers at discharge. Table 2.  Process Measures of Quality Care for Diabetes in Adults Aged 18 and Older, United States, 2000a MeasureEstimateSEPercent of adults age 18+ with diabetes who reported receiving influenza immunization in past year54.82.2Percent of adults age 18+ with diabetes who reported having a foot examination in past year66.41.73Percent of adults age 18+ with diabetes who reported having a retinal eye examination in past year66.51.76Percent of adults age 18+ with diabetes who reported having a hemoglobin A1c measurement at least once in past year89.81.27Percent of adults age 18+ with diabetes who reported receiving a lipid profile in past two years94.30.87Percent of adults age 18+ with diabetes who reported havingall five major tests done in the past two years23.11.5 aData from Medical Expenditure Panel Survey, 2000 (20).