populations which showed the most improvement in quality measures are diabetes, Composite measure: Adults with diabetes who had hemoglobin A1c measurement, …
Key Themes and Highlights From the National Healthcare Quality Report
The National Healthcare Quality Report NHQR is a comprehensive national
overview of the quality of health care in the United States It is a
companion report to the National Healthcare Disparities Report NHDR,
which is a comprehensive national overview of disparities in health care
affecting racial, ethnic, and socioeconomic groups and priority
populations The 2005 NHQR presents the third annual opportunity to measure
the Nations health care quality and to track trends over time-the primary
intent of Congresss mandate to the Agency for Healthcare Research and
Quality AHRQ to produce the NHQR
The NHQR is built on 179 measures assembled across four dimensions of
quality-effectiveness, patient safety, timeliness, and patient
centeredness This years report focuses on the state of health care
quality for a group of 46 core report measures which represent the most
important and scientifically credible measures of quality for the Nation,
as selected by the Department of Health and Human Services HHS
Interagency Work Groupi The distillation of 46 core measures for the 2005
report provides a more readily understandable
summary and explanation of
the key results derived from the dataii Also included in the report are
four new composite measures, which summarize data from a collection of
individual measures Composite measures were created for heart attack,
heart failure, pneumonia, and patient centered care, in addition to an
overall measure of the state of health care quality improvement
Four themes that emerge from the 2005 NHQR extend the meaning of those from
the 2003 and 2004 reports and add new dimensions on understanding change
over time:
Health care quality continues to improve at a modest pace across most
measures of quality
Health care quality improvement is variable, with notable areas of
high performance
Health care quality is improving, but more remains to be done to
achieve optimal quality
Sustained rates of quality improvement are possible
i The HHS Interagency Work Group, which represents 18 HHS agencies and
offices, was formed to provide advice and support to the report team
ii Data on all NHQR measures are available in the Data Tables Appendix at
wwwqualitytoolsahrqgov
Health Care Quality Continues To Improve at a Modest Pace Across
Most
Measures of Quality
Most measures of quality demonstrate improvement over the 2004 NHQR:
Of the 44 core report measures with trend data, 23 showed
significantiii improvement, 2 showed significant deterioration, and 19
stayed the same Figure H1
Measures that improved significantly outnumbered those that
deteriorated significantly by a large margin of over 10 to 1
A sizable percentage of the measures 43 showed no significant
change
Figure H1 Number of NHQR core measures showing significant improvement,
no significant change, or deterioration over multiple years n44
Note: The average annual improvement for each measure is reported here For
trend analyses of the core measures in this report, 3 years of data are
presented; for a few, only 2 years are shown; and for others, more than 3
years are presented
However, the pace of improvement overall is modest Of the 44 core report
measures with trend data:
The frequency distribution of the average annual rate of change for
all core measures is skewed toward improvement such that there were 36
measures that showed some improvement significant and
not
significant and 8 that deteriorated Figure H2
The median rate of annual change for the 44 core measures is a 28
improvement This is the same rate of improvement as reported in the
2004 NHQRiv
Six measures showed annual improvement of more than 10 whereas no
measure showed deterioration of greater than 10
Figure H2 Frequency distribution of the number of core measures by annual
rate of change n44
Note: For trend analyses of the core measures in the 2005 reports, 3 or
more years of data are available for most measures in the measure sets; for
a few, only 2 years are available
iii Significance is defined as a statistical difference with a p value less
than 005 and with an average change of 1 or more per year over a period
of 2 or more years, depending on the measure For more detail, see Chapter
1, Introduction and Methods
iv Different methods were used to determine the median rate of improvement
in this report versus the 2004 report This year, the NHQR reports on core
versus all measures with two data points, annual change versus report-to-
report change, and the geometric average versus arithmetic average
in
determining annual change For more details, see Chapter 1, Introduction
and Methods
Health Care Quality Improvement Is Variable, With Notable Areas of High
Performance
Of the four dimensions of health care quality, measures of patient safety
showed the greatest improvement:
The five core measures of patient safety improved by an overall median
of 102, with a range of 2 to 39 Figure H3
The patient safety improvement rate is 34 times the rate for
effectiveness measures 30 and over 5 times the rate for patient
centeredness and timeliness measures combined 19
Figure H3 Median rate of improvement, by health care dimension
Figure H3 Median rate of improvement, by health care dimension bar
chart Patient Safety n5, 102 percent, Effectiveness n35, 30
percent, Timeliness, Patient Centered n4, 19 percent,
Within the effectiveness component, a subset of measures of care for
certain measure areas contribute most to overall improvement:
The diseases and populations which showed the most improvement in
quality measures are diabetes, heart disease, respiratory conditions,
nursing home care, and maternal and
child health care The overall
rate of change for these measures was 54
The diseases and populations which showed the least improvement in
quality measures are HIV and AIDS, cancer, end stage renal disease,
mental health and substance abuse, and home health care The overall
rate of change for these measures was 03
Medicares Quality Improvement Organization QIOv measures for the
treatment of heart disease and pneumonia showed a much higher rate of
improvement than non-QIO measures:
Medicares QIO measures for heart disease and pneumonia showed a
combined rate of improvement 92 that was almost four times the
combined rate for all the other measures 25 Figure H4
Figure H4 Improvement rate for QIO measures versus non-QIO measures
Health Care Quality Is Improving, but More Remains To Be Done To Achieve
Optimal Quality
Many measures showing significant improvement are far from meeting Healthy
People 2010vi objectives, such as:
Breast cancer Between 1999 and 2002, the number of age-adjusted
breast cancer deaths per 100,000 population decreased significantly
from 266 to 256 At this pace, the
Healthy People 2010 target of
223 will not be met Even when this target is met, approximately
40,000 women will still die from breast cancer annually
End stage renal disease The percentage of dialysis patients on the
waiting list for transplantation improved from 147 in 1998 to 159
in 2002 The rate is well below the Healthy People 2010 target of 66
At this pace, the target will not be met for 70 years
High blood pressure Among those treated for high blood pressure, the
proportion who have it under control increased significantly from 23
in 1988-1994 to 29 in 1999-2002 The Healthy People 2010 target is
50 At this pace, the target will not be met for 20 years
Pneumonia The percentage of adults age 65 and over who ever received
pneumococcal vaccination increased significantly from 499 in 1999 to
557 in 2003 The Healthy People 2010 target is 90 At this pace of
change, it will take 15 years to meet the target
Many measures are slow to change and present significant challenges to
quality improvement Examples include:
Breast cancer The overall rate of late stage breast cancer has not
changed over
the past 10 years
AIDS The rate of new AIDS cases has not changed over the past 5 years
and remains 17 times higher than the Healthy People 2010 target
Smoking Over a third of patients hospitalized with a heart attack who
smoke report that their doctor did not advise them to quit smoking
This rate has not changed over the last 3 years
Overuse of antibiotics The rate of outpatient visits for the common
cold in which antibiotics were prescribed has not changed over the
past 5 years and is 35 higher than the Healthy People 2010 target
Heart attack Among Medicare heart attack patients, the median time
from arrival to the initiation of thrombolytic therapy has not changed
over the past 3 years and is 50 longer than the national target
Medication errors The percentage of elderly that had 1 of 11 drugs
that should always be avoided by the elderly remained unchanged at
about 3 over the past 6 years
List of Core Report Measures
http://wwwqualitytoolsahrqgov/qualityreport/2005/browse/browseaspx?id92
86
|MEASURE
|Measure |Measure |National |State |
| |number |specifications|database |database |
| | | | | |
|EFFECTIVENESS OF CARE |
|CANCER |
|Screening for breast cancer: |
|Women age 40 and over who had a mammogram |11 |HP20103-13 |NHIS |BRFSS |
|within the past 2 years | | | | |
|Rate of breast cancers diagnosed at late |12 |SEER program |SEER |NPCR |
|stage | | | | |
|Cancer treatment: |
|Cancer deaths per 100,000 female population|110 |HP20103-3 |NVSS-M |NVSS-M |
|per year for breast cancer | | | | |
|DIABETES
|
|Management of diabetes: |
|Composite measure: Adults with diabetes who|115 |Specs for MEPS|MEPS |na |
|had hemoglobin A1c measurement, retinal eye| | | | |
|exam, and foot exam in the past year | | | | |
|Hospital admissions for lower extremity |127 |HP 20105-10 |NHDS |HCUP SID |
|amputations in patients with diabetes per | | | | |
|1,000 population | | | | |
|END STAGE RENAL DISEASE |
|Management of End Stage Renal Disease: |
|Dialysis patients registered on the waiting|128 |HP2010 4-5 |USRDS |USRDS |
|list for transplantation | | | | |
|Hemodialysis patients with urea reduction |130 |CMS |ESRD |UMichiga|
|ratio 65 or higher | | |Clinical
|n |
| | | |Performanc| |
| | | |e Measures| |
| | | |Project | |
|HEART DISEASE |
|Counseling on risk factors: |
|Current smokers age 18 and over receiving |136 |HP20101-3c |MEPS |BRFSS |
|advice to quit smoking | | | | |
|Treatment of acute myocardial infarction AMI: |
|Composite measure: Hospital care for heart |137 |QIO scope of |QIO |na |
|attack patients | |work | | |
|Treatment of acute heart failure: |
|Composite measure: Hospital care for heart |146 | QIO scope of |QIO |na |
|failure patients | |work | | |
|Heart
Disease Treatment: |
|Deaths per 1,000 adult admissions with |155 |AHRQ-QI |HCUP NIS |na |
|acute myocardial infarction | | | | |
|HIV and AIDS |
|AIDS prevention: |
|New AIDS cases per 100,000 population 13 |157 |HP201013-1 |CDC-AIDS |na |
|and over | | | | |
|Management of HIV/AIDS: |
|HIV patients with CD4 200 who receive PCP |159 | |HIV |na |
|prophylaxis | | |Research | |
| | | |Network | |
|MATERNAL AND CHILD HEALTH |
|Maternity care: |
|Pregnant women
receiving prenatal care in |161 |HP201016-6a |NVSS-N |NVSS-N |
|first trimester | | | | |
|Infant mortality per 1,000 live births, by |163 |HP201016-1c |NVSS-I |NVSS-I |
|birth weight | | | | |
|Immunization, childhood: |
|Children 19-35 months who received all |165 |HP201014-24a|NIS |NIS |
|recommended vaccines | | | | |
|Immunization, adolescent: |
|Adolescents 13-15 who received 3 or more |166 |HP201014-27a|NHIS |na |
|doses of hepatitis B vaccine | | | | |
|Childhood dental care: |
|Children 2-17 with a dental visit in last |170 |HP 201021-10|MEPS |na |
|year | | | | |
|Treatment of pediatric gastroenteritis:
|
|Hospital admissions for pediatric |171 |AHRQ-QI |HCUP NIS |HCUP SID |
|gastroenteritis per 100,000 population less| | | | |
|than 18 years of age | | | | |
|Childhood preventive care |
|Children 2-17 with advice about physical |173 |Specs for MEPS|MEPS |na |
|activity | | | | |
|MENTAL HEALTH AND SUBSTANCE ABUSE |
|Treatment of mental illness: |
|Adults diagnosed with a new episode of |181 |NCQA |HEDIS |na |
|depression and initiated on an | | | | |
|antidepressant drug who remained on an | | | | |
|antidepressant medication through the | | | | |
|continuation phase of treatment | |
| | |
|Suicide deaths per 100,000 population |182 |HP201018-1 |NVSS-M |NVSS-M |
|Adults with serious psychological distress |183 |SAMHSA |SAMHSA |na |
|who receive mental health treatment or | | | | |
|counseling | | | | |
|Treatment of substance abuse |
|Persons age 12 and over who needed |185 |SAMHSA |SAMHSA |na |
|treatment for substance abuse who received | | | | |
|such treatment | | | | |
|Patients receiving substance abuse |186 |TEDS |TEDS |na |
|treatment who completed treatment | | | | |
|RESPIRATORY DISEASES |
|Immunization, pneumonia: |
|Persons 65 and over who ever received |191 |HP201014-29b|NHIS |BRFSS
|
|pneumococcal vaccination | | | | |
|Treatment of pneumonia: |
|Composite measure: Hospital care for |192 | QIO scope of |QIO |na |
|pneumonia patients | |work | | |
|Treatment of upper respiratory infection URI: |
|Rate antibiotics prescribed at visits with |199 |HP201014-19 |NAMCS-NHAM|na |
|a diagnosis of common cold per 10,000 | | |CS | |
|population | | | | |
|Management of asthma: |
|People with persistent asthma prescribed |1100 |NCQA |HEDIS |na |
|medications acceptable as primary therapy | | | | |
|for long-term control of asthma inhaled | | | | |
|corticosteroids | | | | |
|Hospital admissions for
asthma per 100,000 |1101 |AHRQ-QI |HCUP NIS |HCUP SID |
|population under 18 | | | | |
|Treatment of TB: |
|Tuberculosis patients who complete course |1104 |HP2010 14-12|CDC, TB |na |
|of treatment within 12 months of treatment | | | | |
|initiation | | | | |
|NURSING HOME AND HOME HEALTH CARE |
|Nursing facility care: |
|Long-stay nursing home residents who were |1107 |CMS |na | |
|physically restrained | | | | |
|High risk long-stay nursing home residents |1112 |CMS |na | |
|with pressure sores | | | | |
|Low risk long-stay nursing home residents |1113 |CMS |na |MDS |
|with pressure sores |
| | | |
|Short-stay nursing home residents who have |1118 |CMS |na |MDS |
|pressure sores | | | | |
|Home health care: |
|Home health care patients who get better at|1125 |CMS |na |OASIS |
|walking or moving around | | | | |
|Home health care patients who had to be |1131 |CMS |na |OASIS |
|admitted to the hospital | | | | |
|SAFETY |
|Complications of care: |
|Central line-associated bloodstream |26 |HP201014-20b|NNIS |na |
|infection in intensive care unit ICU | | | | |
|patients | | | | |
|Intensive care unit patients - |224 |CDC |NNIS
|na |
|ventilator-associated pneumonia | | | | |
|Medicare beneficiaries with postoperative |226 |CMS |MPSMS |na |
|pulmonary embolus or deep vein thrombosisiv| | | | |
|Medicare beneficiaries with central venous |228 |CMS |MPSMS |na |
|catheter-associated mechanical complication| | | | |
|Prescribing medications: |
|Elderly with inappropriate medications |238 |AHRQ |MEPS |na |
|TIMELINESS |
|Getting appointments for care: |
|Adults who always can get care for illness |35 |Specs for MEPS|MEPS |NCBD |
|or injury as soon as wanted | | | | |
|Waiting time: |
|Emergency department visits in which the |38 |NCHS |NAMCS-NHAM|na |
|patient
left without being seen | | |CS | |
|PATIENT CENTEREDNESS |
|Patient experience of care: |
|Composite measure: Adults whose health |41 |Specs for MEPS|MEPS |na |
|providers always listened carefully, | | | | |
|explained things, showed respect, and spent| | | | |
|enough time with them | | | | |
|Composite measure: Children whose health |42 |Specs for MEPS|MEPS |na |
|providers always listened carefully, | | | | |
|explained things, showed respect, and spent| | | | |
|enough time with them | | | | |
Key to abbreviations:
AHRQ-QI AHRQ Quality Indicators
BRFSS Behavioral Risk Factor Surveillance System
CDC TB Centers for Disease Control Prevention National Tuberculosis
Surveillance System
CDC AIDS
Centers for Disease Control and Prevention HIV/AIDS Surveillance
System
CMS Centers for Medicare Medicaid Services
HCUP NIS Healthcare Cost and Utilization Project Nationwide Inpatient
Sample
HCUP SID Healthcare Cost and Utilization Project State Inpatient
Databases
HP2010 Healthy People 2010
ESRD End Stage Renal Disease
HEDIS Health Plan Employer Data and Information Set
MEPS Medical Expenditure Panel Survey
MPSMS Medicare Patient Safety Monitoring System
MDS Minimum Data Set
NAMCS-NHAMCS National Ambulatory Medical Care Survey-National Hospital
Ambulatory Medical Care Survey
NCBD National CAHPS Benchmarking Database
NCQA National Committee for Quality Assurance HEDIS measure set
NHIS National Health Interview Survey
NHDS National Hospital Discharge Survey
NIS National Immunization Survey
NNIS National Nosocomial Infections Surveillance
NPCR National Program of Cancer Registries
NTBSS National TB Surveillance System
NVSS-I National Vital Statistics System -Linked Birth and Infant Death
Data
NVSS-M National Vital Statistics System, Mortality
NVSS-N National Vital Statistics System, Natality
OASIS Outcome and Assessment Information Set
QIO Quality Improvement
Organization program
SAMSHA Substance Abuse and Mental Health Services Administration
SEER Surveillance, Epidemiology, and End Results Program
TEDS Treatment Episode Data Set
USRDS United States Renal Data System
UMichigan University of Michigan Kidney Epidemiology and Cost Center
na Not applicable
Source:fdhc.state.fl.us
