National Healthcare Quality Report, 2010

Health care seeks to prevent, diagnose, and treat disease and to improve the physical and mental well-being of all Americans. Across the lifespan, health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with death and dying. Quality health care delivers these services in ways that are safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need, or they receive care that causes harm. Care can be delivered too late or without full consideration of a patient's preferences and values. Many times, our system of health care distributes services inefficiently and unevenly across populations. Some Americans receive worse care than other Americans. These disparities may be due to differences in access to care, provider biases, poor provider-patient communication, and poor health literacy. Since 2003, the Agency for Healthcare Research and Quality (AHRQ) has reported on progress and opportunities for improving health care quality and reducing health care disparities. Guided by a subcommittee of AHRQ's National Advisory Council and a Department of Health and Human Services (HHS) Interagency Work Group, past reports were built on more than 250 measures categorized across six dimensions: effectiveness, patient safety, timeliness, patient centeredness, efficiency, and access to care. The Institute of Medicine (IOM) first provided guidance to AHRQ on the NHQR and NHDR in 2002. In 2008, AHRQ asked the IOM to offer suggestions for enhancing future reports and associated products to ensure that these reports raise awareness of the performance of the U.S. health care system. Findings from the 2010 NHQR and 2010 NHDR have been integrated into a single summary document. This is intended to reinforce the need to consider simultaneously the quality of health care and disparities across populations when assessing our health care system. The National Healthcare Reports Highlights seeks to address three questions critical to guiding Americans toward the optimal health care they need and deserve: What is the status of health care quality and disparities in the United States? How have health care quality and disparities changed over time? Where is the need to improve health care quality and reduce disparities greatest? The 2010 reports emphasize one of AHRQ's priority populations as a theme. This year, we present expanded analyses of care across the urban-rural continuum, and the National Healthcare Reports Highlights includes a summary of care received by residents of different types of geographic areas. Finally, this document summarizes information on eight national priorities identified by the IOM Committee and presents novel strategies for improving quality and reducing disparities from AHRQ's Health Care Innovations Exchange (HCIE). Four themes from the 2010 NHQR and 2010 NHDR emphasize the need to accelerate progress if the Nation is to achieve higher quality and more equitable health care in the near future. Health care quality and access are suboptimal, especially for minority and low-income groups; Quality is improving; access and disparities are not improving; Urgent attention is warranted to ensure improvements in quality and progress on reducing disparities with respect to certain services, geographic areas, and populations, including: Cancer screening and management of diabetes; States in the central part of the country; Residents of inner-city and rural areas; Disparities in preventive services and access to care. Progress is uneven with respect to eight national priorities: Two are improving in quality: Palliative and End-of-Life Care and Patient and Family Engagement; Three are lagging: Population Health, Safety, and Access; Three require more data to assess: Care Coordination, Overuse, and Health System Infrastructure; All eight priority areas showed disparities related to race, ethnicity, and socioeconomic stat