"The 2004 National Healthcare Quality Report and its companion 2004 National Healthcare Disparities Report provide a benchmark on the quality of care and health disparities in our country, and they also track the progress we are making," said AHRQ Director Carolyn M. Clancy, M.D. "This is important information for those who wish to improve health care quality and access to services for all individuals."

The Quality Report identifies three key themes important to policymakers, clinicians, health system administrators, community leaders and others who work in health care services. The report finds that:

• Quality is improving in many areas, but change takes time.

• The gap between the best possible care and actual care remains large.

• Quality of care remains highly variable across the country.

Further improvement in health care is possible. Best practices have been identified, and collaborative, focused efforts among key stakeholders have produced impressive and inspiring gains.

In comparison to data reported in the 2003 Quality Report, modest improvement has been noted in many of the report's quality measures. Across the entire set of Quality Report measures, quality has improved by approximately 3 percent versus data reported in the 2003 report. These include selected measures used by HHS' Centers for Medicare & Medicaid Services, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and others for quality reporting on hospitals, nursing homes, home health agencies and other settings. In addition, since the 2003 Quality Report, improvements have been made in specific measures related to health care delivery.

The greatest changes were in the following:

• A decrease of 37 percent from 2002 to 2003 in the percentage of nursing home patients who have moderate or severe pain.

• A decrease of 34 percent from 1994 to 2001 in the hospital admission rate for uncontrolled diabetes.
   

• A decrease of 34 percent from 1996 to 2000 in the percentage of elderly patients who were given potentially inappropriate medications.

Quality remains variable across the country. However, improvements were seen in many areas at the State level. Some of these notable improvements are:

• Minnesota—Largest improvement in State rank for mammogram testing rates.
   

• Alabama—Only State to significantly increase screening rates for two recommended tests for colorectal cancer.

Data for all States are available in the report's Tables Appendix and Measure Specifications Appendix.

The 2004 National Healthcare Disparities Report presents data on the same clinical conditions and other measures as the Quality Report but focuses on priority populations, including women, children, the elderly, racial and ethnic minority groups, low-income groups, residents of rural areas, and individuals with special health care needs, specifically children with special needs, people in need of long-term care and people requiring end-of-life care.

The 2004 Disparities Report identifies three key themes:

• Disparities are pervasive.
   

• Improvement is possible.
   

• Gaps in information exist, especially for specific conditions and populations.

A subset of measures with the comparable data for 2000 and 2001 is highlighted in the 2004 Disparities Report. In both years:

• Blacks received poorer quality of care than whites for about two-thirds of quality measures and had worse access to care than whites for about 40 percent of access measures.

• Asians received poorer quality of care than whites for about 10 percent of quality measures and had worse access to care than whites for about a third of access measures.

• American Indians and Alaska Natives received poorer quality of care than whites for about a third of quality measures and had worse access to care than whites for about half of access measures.

• Hispanics received lower quality of care than non-Hispanic whites for half of quality measures and had worse access to care than non-Hispanic whites for about 90 percent of access measures.

• Poor people received lower quality of care for about 60 percent of quality measures and had worse access to care for about 80 percent of access measures than those with high incomes.

The 2004 Disparities Report found improvement in care provided to the nation's poor, uninsured and minorities through federally supported health centers. These centers, administered by HHS' Health Resources and Services Administration, focus specifically on providing care to vulnerable populations. In 2004, over 3,600 health centers sites delivered primary and preventive care to 13.2 million people.

The FY 2006 budget will complete the President's commitment to create 1,200 new or expanded health center sites resulting in the delivery of primary and preventive health care services to 6.1 million additional people, many of whom face multiple barriers to receiving health care. In addition, the President has established a new goal to help every poor county in America in need that lacks a health center and can support one. Forty new health center sites will be funded in FY 2006 for this new effort.

In addition, AHRQ has recently announced a new partnership designed to help reduce disparities in health care for people with diabetes and other conditions. "The National Health Plan Learning Collaborative To Reduce Disparities and Improve Quality" is the first national effort of its kind to go beyond research and actively tackle racial and ethnic inequities in health care service delivery.

Over the next 3 years, the collaborative will test ways to improve the collection and analysis of data on race and ethnicity, match those data to existing Health Plan Employer Data and Information Set quality measures, develop quality improvement interventions that close the gaps in care and produce results that can be replicated by other health insurers and providers serving Medicare, Medicaid and commercial populations.

Some Significant Deterioration Found

Some deterioration in selected measures impacting many senior citizens was noted.The largest of these are:

• An increase of 32% in the proportion of patients who left the Nation’s emergency departments without being seen (National Hospital Ambulatory Medical Care Survey, 2000-2001).

• A decrease of 20% in the proportion of elderly patients with pneumonia who received their initial antibiotic according to current clinical recommendations (Centers for Medicare & Medicaid Services, Quality Improvement Organization [CMS QIO] program, 2002).

• An increase of 12% in the admission rate for short-term complications of diabetes (Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project [AHRQ, HCUP] Nationwide Inpatient Sample, 2001).

Patients in the highest performing States are getting care at a level of quality many times higher than that of the lowest performing States. For example:

• Nursing home residents were physically restrained at a rate over 9 times higher in the lowest performing State versus the highest performing State (CMS, 2003).

• The proportion of elderly patients with pneumonia who received recommended pneumococcal screenings or vaccinations was over 7.5 times lower in the lowest performing State versus the highest performing State (CMS, QIO program, 2002).

• The median time to critical thrombolytic therapy for heart attack patients was 6.6 times longer in the lowest performing State (2 hours and 20 minutes) versus the highest performing State (21 minutes) (CMS, QIO program, 2001).

The report documents areas in which comprehensiveness of care is lacking:

• Although 90% of persons with diabetes state that they had their hemoglobin A1c checked, only 32% state that they have received all five of the prevention tests recommended for long-term diabetes management ^vi  (AHRQ, Medical Expenditure Panel Survey, 2001).

• Although 80% of elderly hospitalized pneumonia patients get their blood cultured before getting antibiotics as recommended, only 30% get all the recommended interventions for elderly patients admitted with pneumonia ^vii  (CMS, QIO program, 2001-2002).

The National Healthcare Quality Report and National Healthcare Disparities Report are available on AHRQ's QualityTools Web site at http://www.qualitytools.ahrq.gov. The site serves as a Web-based clearinghouse to make it easier for health care providers, policymakers, purchasers, patients and consumers to take effective steps to improve quality. Print copies of the reports also can be obtained by calling 1-800-358-9295 or by sending an E-mail to ahrqpubs@ahrq.gov.

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