National Healthcare Quality and Disparities Reports

1
National Healthcare Quality and Disparities
Reports

• Ernest Moy, MD, MPH
• Center for Quality Improvement and Patient Safety

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Congressional Mandate

• Mandated by Congress in the Healthcare
• Research and Quality Act (PL. 106-129)
• National trends in the quality of health care
  provided to the American people
• Prevailing disparities in health care delivery
  as it relates to racial factors and socioeconomic
  factors in priority populations

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How the Reports are Related
NHQR NHDR
Snapshot of quality of health care in America Snapshot of disparities in health care in American
Quality Quality Access
Variation across states Variation across populations
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Goals of the Reports

• National Level
• Provide assessment of disparities and quality
• Provide baselines to track progress
• Identify information gaps
• Emphasize interdependence of disparities and
  quality
• Promote awareness and change
• State / Local / Provider Level
• Provide tools for self-assessment
• Provide national benchmarks
• Promote awareness and change

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Measure Topics

• Quality of Health Care
• Effectiveness
• Cancer, Diabetes, ESRD, Heart Disease, HIV/AIDS,
  Maternal and Child Health, Mental Disease,
  Respiratory Disease, Nursing Home and Home Health
  Care
• Safety
• Timeliness
• Patient centeredness

• Access to Health Care
• Getting into the system
• Insurance, Usual Source of Care, Perceptions of
  Need
• Getting care within the system
• Perceptions of care
• Patient-provider communication, relationship
• Health care use

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Databases

• Surveys collected from samples of civilian,
  noninstitutionalized populations
• AHRQ, Medical Expenditure Panel Survey (MEPS),
  1998-2000
• California Health Interview Survey (CHIS), 2001
• CDC-NCHS, National Health and Nutrition
  Examination Survey (NHANES), 1999-2000
• CDC-NCHS, National Health Interview Survey
  (NHIS), 1998 and 2000
• CDC-NCHS/National Immunization Program, National
  Immunization Survey (NIS), 2001
• CMS, Medicare Current Beneficiary Survey (MCBS),
  1999
• The Commonwealth Fund, Health Care Quality
  Survey, 2001
• NCHS, National Health and Nutrition Examination
  Survey (NHANES), 1999-2000
• NCHS, National Health Interview Survey (NHIS),
  1998 and 2000
• NCHS, National Immunization Survey (NIS), 2001
• SAMHSA, National Household Survey of Drug Abuse
  (NHSDA), 2000.
• Data collected from samples of health care
  facilities
• CDC-NCHS, National Ambulatory Medical Care Survey
  (NAMCS), 1999-2000
• CDC-NCHS, National Home and Hospice Care Survey
  (NHHCS), 2000
• CDC-NCHS, National Hospital Ambulatory Medical
  Care Survey-Outpatient Department (NHAMCS-OPD),
  1999-2000
• CDC-NCHS, National Hospital Ambulatory Medical
  Care Survey-Emergency Department (NHAMCS-ED),
  1999-2000
• CDC-NCHS, National Hospital Discharge Survey
  (NHDS), 1998-2000
• CDC-NCHS National Nursing Home Survey (NNHS),
  1999

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Key Findings from the 2004 Reports

• Disparities are pervasive.
• Improvement is possible, but change takes time.
• Gaps in information exist, especially for
  specific conditions and populations.

• The gap between the best possible care and actual
  care remains large.
• Quality is improving in many areas, but change
  takes time.
• Further improvement in health care is possible.

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Disparities are pervasive.
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Gaps in information exist.
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Quality is improving but change takes time.
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Getting to improvement

• Produce and publish products and tools for
  various audiences
• Develop partnerships for dissemination and
  implementation
• Design and manage major outreach programs

KNOW
DO
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Products

• Everyone
• www.qualitytools.ahrq.gov
• Fact Sheets / Knowledge Packs
• Summit Improving Health Care for All Americans
• States
• Resource Guides for State Action
• Diabetes (2004) Asthma (2005)
• State Rankings / Snapshots
• State Diabetes Partnerships
• Employers
• Employer Diabetes Partnerships

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Patient Safety in the Reports

• National Nosocomial Infection Survey
• Medicare Patient Safety Monitoring System
• AHRQ Patient Safety Indicators
• MEPS Inappropriate Medications

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Possible Uses of the NHQR for Improving Patient
Safety

• Promote awareness and change
• Reduce fear
• Safety is a national problem
• Safety can and does get better
• Provide tools for self-assessment
• Common language
• National benchmarks and baselines
• Identify information gaps

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Possible Uses of the NHDR for Improving Patient
Safety

• Promote awareness and change
• Set improvement targets
• Target improvement activities
• Level the comparative playing field

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Using Disparities to Target Improvement Activities
Ineffective, Unsafe, Untimely, Not Patient
Centered, Inefficient
Inequitable Uninsurance, Poverty, Language, Cultu
re, Bias
Actual Care for the Disadvantaged
Actual Care for the Advantaged
Actual Care
High Quality Care

Disparities Chasm
Quality Chasm
Quality Improvement for the Disadvantaged
Ineffective, Unsafe, Untimely, Not Patient
Centered, Inefficient, Inequitable
High Quality Care
Actual Care for the Disadvantaged
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Level the Comparative Playing Field Nosocomial
Infections
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Level the Comparative Playing Field 3rd Degree
OB Lacerations
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AHRQ Quality Connect

• 1 Million initiative announced at Summit
• Program elements?
• Partnerships with
• State policy makers
• Quality improvement officers
• Improvements in 5-10 quality measures.
• Creation of a robust communication and action
  infrastructure.
• Sharing of successful practices
• A national information infrastructure

O U T R E A C H
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We need your help

• Review Reports
• Review www.qualitytools.ahrq.gov
• Provide advice about
• Adding and refining patient safety measures
• Accessibility and usability of reports and tools
• Tell us about your experiences
• Measuring quality and disparities
• Improving safety
• Reducing disparities

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Contact information

• www.qualitytools.ahrq.gov
• Report requests Giovanna Williams
• [phone]
• gwilliam_at_ahrq.gov

• Dr. Ernie MoyLead Staff, NHDR301-427-1329emoy_at_a
  hrq.gov

• Dr. Dwight McNeillLead Staff, NHQR301-427-1734d
  mcneill_at_ahrq.gov