Hospitals Lead in Quality Improvement Gains

Hospitals are leading the movement to improve the quality of care delivered to U.S. patients, outpacing improvements in other settings, according to two national reports issued by the Agency for Healthcare Research and Quality (AHRQ). Three-quarters of hospital quality measures showed significant improvement, compared with 60 percent for home health and nursing home care, and about half for ambulatory settings.

The 2013 National Healthcare Quality Report and National Healthcare Disparities Report shows that Americans are receiving recommended medical services 70 percent of the time. The reports include data based on hundreds of healthcare measures categorized in several areas of quality. These are effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure and access. This marks the 11th year AHRQ has reported on the state of national healthcare quality and disparities.

The reports also indicate that public reporting of quality measures through venues such as CMS' Hospital Compare Web site may have contributed to improvements. Fourteen of the 16 quality measures that reached a 95 percent performance level were publicly reported by CMS. Another four CMS measures are among those improving at the fastest pace. Every CMS measure tracked in the reports and publicly reported on the Hospital Compare site showed improvement over time, compared with 60 percent of hospital measures that are not publicly reported by CMS.

Consistent with other national reports, including a CMS report released May 7, rates of some healthcare-associated infections, or HAIs, are beginning to fall while processes to prevent hospital readmission are improving. Quality also has improved for measures on adolescent vaccination, HIV treatment, colon cancer surgical care and hospital care for patients with heart problems and pneumonia. Quality worsened for measures on diabetes checkups, Pap smears, maternal deaths at delivery and preventive care for patients with asthma.

The reports also found deficiencies regarding health care access, with 26 percent of Americans (especially racial and ethnic minorities and low-income people) reporting difficulties getting care. Most disparities in quality of care that were related to race, ethnicity or income showed no significant change. However, for blacks, Hispanics, Asians and poor people, the number of disparities showing improvement was larger than the number of disparities that were getting worse.

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