1. 2008 National Healthcare Quality Report (NHQR) Health care quality is suboptimal and continues to improve at a slow pace Released May 6, 2009

2. Annual Median Rate of Change Median annual rate of change for the 45 core measures = 1.8% Median annual rate of change for the 45 core measures = 1.8% Highest rate of improvement (2.5%) in measures related to acute treatment Highest rate of improvement (2.5%) in measures related to acute treatment n = number of measures

3. Variation in Quality Receipt of care varies widely: Receipt of care varies widely: – Patients hospitalized with a heart attack receive 95% of recommended services – Only 15% of patients on dialysis are registered on a kidney transplant waiting list Across report measures, the median level of receipt of needed care was 59% Across report measures, the median level of receipt of needed care was 59%

4. Hospital Quality Leading Improvement Median annual rate of change for hospital measures twice the rate for all measures Median annual rate of change for hospital measures twice the rate for all measures  Lowest rate for ambulatory care measures, but at least some improvement in 75% of these measures n = number of measures

5. Patient Safety Lagging Safety measures only area to show an overall decline, with only 45% of the measures showing at least some improvement (17 out of 38) Safety measures only area to show an overall decline, with only 45% of the measures showing at least some improvement (17 out of 38) n = number of measures

6. Health Care Quality Measurement Evolving Goals Goals – Address emerging issues – Coordinate measure development – Enable health information technology to support quality improvement – Promote data standardization

7. 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. 106-129)

8. NHQR and NHDR Goals Provide a snapshot of health care delivery Provide a snapshot of health care delivery – 45 core measures of quality and access – 220 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

9. 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

10. 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

11. 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

12. New in the 2008 NHQR Chapter 2: Chapter 2: – Heart disease: Analysis of counseling obese adults about healthy eating – Mental health: New measure on receipt of minimally adequate treatment by adults with mental disorders – Respiratory disease: New measure on daily preventive medicine use for current asthma – Hospice care: New measure on caregivers’ perception of referral to hospice at the right time Chapter 3: Additional patient safety measures Chapter 3: Additional patient safety measures Chapter 6: New measure on rehospitalizations for congestive heart failure Chapter 6: New measure on rehospitalizations for congestive heart failure

13. For more information… NHQR and NHDR Web page http://www.ahrq.gov/qual/qrdr08.htm http://www.ahrq.gov/qual/qrdr08.htm NHQRDRnet for data tables and queries http://nhqrnet.ahrq.gov/nhqr/jsp/nhqr.jsp Request a copy (AHRQ publication no. 09-0001) from AHRQ Publications Clearinghouse 1-800-358-9295 or AHRQPubs@ahrq.hhs.gov AHRQPubs@ahrq.hhs.gov