2007 National Healthcare Quality Report (NHQR) Health care quality continues to improve, but the rate of improvement has slowed Released March 3, 2008

Annual Median Rate of Change The annual median rate of change from 1994 to 2005 was 2.3% The annual median rate of change from 1994 to 2005 was 2.3% From 2000 to 2005, the annual median rate of change was 1.5% From 2000 to 2005, the annual median rate of change was 1.5% n=number of measures

Improvement in Core Measures Most measures show some improvement Most measures show some improvement Of the 41 core measures reported with data that span : Of the 41 core measures reported with data that span : – 27 improved – 6 declined – 6 showed no change

Variation in Health Care Quality Variation in quality of health care across the Nation is decreasing, but not for all measures Variation in quality of health care across the Nation is decreasing, but not for all measures More measures have seen progress in terms of decreases in variation between the best performing State and the worst performing State between 2000 and 2005: More measures have seen progress in terms of decreases in variation between the best performing State and the worst performing State between 2000 and 2005: – Variability decreased for 28 measures – Variability increased for 13 measures – There was no change for 18 measures

Example of Decreased Variation Heart attack patients given smoking cessation counseling while hospitalized Source: CMS, Medicare Quality Improvement Organization Program

Patient Safety The safety of health care has improved since 2000, but more needs to be done The safety of health care has improved since 2000, but more needs to be done n=number of measures

Rates of Improvement Safety improved slightly between 2000 and 2005, at an annual rate of 1% Safety improved slightly between 2000 and 2005, at an annual rate of 1% Other areas improved at significantly greater rates, such as care for heart disease (5.6%) Other areas improved at significantly greater rates, such as care for heart disease (5.6%)

Rates of Improvement Areas where significant attention has been concentrated, such as appropriate timing of antibiotics for surgery and reducing medication errors, have shown progress: Areas where significant attention has been concentrated, such as appropriate timing of antibiotics for surgery and reducing medication errors, have shown progress: – Over 30% more patients received appropriate timing for antibiotics before and after surgery in 2005 than in 2004 – From 2004 to 2005, adverse drug events from warfarin and low-molecular-weight heparin declined 21% and 28%, respectively – Deaths following complications of care declined 2.4% from 1994 to 2004

Patient Safety Data In many areas, data needed to track patient safety effectively are not available In many areas, data needed to track patient safety effectively are not available In most cases, clinicians lack basic monitoring data on medical errors and adverse events. For example: In most cases, clinicians lack basic monitoring data on medical errors and adverse events. For example: – Only 25 of 41 safety measures in the full NHQR measure set have data available for tracking recent trends – No national data systems currently report data on safety at a State or local level – Because adverse events and medical errors are rare events from a statistical perspective, it is difficult to compare across time or patient groups

Origin of NHQR Health and Human Services Secretary required to submit annual report to Congress: Health and Human Services Secretary required to submit annual report to Congress: – National trends in health care quality (National Healthcare Quality Report, or NHQR) – Prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations (National Healthcare Disparities Report, or NHDR) Mandated by Congress in Healthcare Research and Quality Act (PL )

NHQR and NHDR Goals Provide a snapshot of health care delivery Provide a snapshot of health care delivery – 41 core measures of quality and access – 211 total measures Indicate the biggest gaps in care Indicate the biggest gaps in care Show national and State trends Show national and State trends Tell us how we can reach our goals Tell us how we can reach our goals Help align measures across public and private quality initiatives Help align measures across public and private quality initiatives

NHQR and NHDR Framework Consumer Perspectives on Health Care Needs Components of Health Care Quality SafetyEffectiveness Patient Centeredness Timeliness Staying healthy Getting better Living with illness or disability Coping with end-of- life matters Source: Institute of Medicine Committee. “Envisioning the National Health Care Quality Report,” 2001

Relationship Between NHQR and NHDR NHQRNHDR Snapshot of quality of health care in America Snapshot of disparities in health care in America Quality Quality + access Safety, effectiveness, timeliness, patient centeredness Safety, effectiveness, timeliness, patient centeredness + equity Variation across States Variation across populations

NHQR/NHDR Content and Organization Effectiveness Effectiveness – Cancer – Diabetes – End Stage Renal Disease (ESRD) – Heart Disease – HIV and AIDS – Maternal and Child Health – Mental Health and Substance Abuse – Nursing Home, Home Health, and Hospice Care Patient Safety Patient Safety Timeliness Timeliness Patient Centeredness Patient Centeredness Access to Health Care Access to Health Care Priority Populations Priority Populations *Also includes a chapter on Efficiency NHQR* NHDR

New in the 2007 NHQR Chapter 2, Cancer: Cancer treatment measures (two for breast cancer, one for colon cancer) from National Cancer Data Base, American Cancer Society and American College of Surgeons Chapter 2, Cancer: Cancer treatment measures (two for breast cancer, one for colon cancer) from National Cancer Data Base, American Cancer Society and American College of Surgeons Chapter 2, HIV and AIDS: HIV testing measures, CDC National Survey on Family Growth Chapter 2, HIV and AIDS: HIV testing measures, CDC National Survey on Family Growth Chapter 2, Nursing Home and Home Health: Pain management for nursing home residents, CDC National Nursing Home Survey Chapter 2, Nursing Home and Home Health: Pain management for nursing home residents, CDC National Nursing Home Survey Chapter 6, Efficiency Chapter 6, Efficiency

For more information… NHQR and NHDR Web page NHQRnet for data tables and queries Request a copy (AHRQ publication no ) from AHRQ Publications Clearinghouse or