April 2008: Volume 34, Number 4
Healthcare Quality Gains Slowing
Though the overall quality of healthcare in the U.S. continues to improve, the rate of improvement has slowed in the past decade, with measures most closely tied to laboratory testing appearing at both the upper and lower ends of progress, according to AHRQ’s annual National Healthcare Quality Report.
Overall quality improved by an average 2.3% a year between 1994 and 2005, down from the 3.1% rate reported in the agency’s 2006 report for 1994–2004. Most measures showed some improvement: out of 41 core measures with available data in 1994–2005, 27 improved, 6 declined, and 6 remained unchanged.
Notable gains were made in care for heart disease and cancer, while improvement in the management of diabetes fell behind. Looking at how many heart attack patients received the recommended tests, medications, and counseling to quit smoking, the report found an average 5.6% annual improvement rate for the 2002–2005 timeframe. The greatest improvement came in the provision of recommend-ed care for patients with heart attacks. Between 2001 and 2005, Medicare patients with heart attacks went from receiving recommended care in 77.2% of cases to 94.5%. Data also showed improvement in inpatient mortality following heart attack, with the overall rate declining from 124.9 to 81.7 deaths per 1,000 admissions with heart attack.
In contrast to the numbers on heart disease, the report suggests the healthcare system is slowing in its management of diabetes. Of adults age 40 and older diagnosed with diabetes, 46.7% received the recommended HbA1c test, retinal exam, and foot exam in 2004, a rate statistically unchanged from 2000. Taking a different timeframe, in 1999–2004, 48.7% of adults age 40 and older diagnosed with diabetes had their HbA1c level under optimal control (<7.0%), again unchanged from the corresponding 1988–1994 rate. The bright spot for diabetes was cholesterol management: 48.2% of those age 40 and over diagnosed with diabetes in 1999–2004 had their total cholesterol under 200mg/dL, up 29.9% over 1988–1994. The report can be found on the HRQ Website.