2008 National Healthcare 2008 National Healthcare Quality Report (NHQR)Quality Report (NHQR)

Health care quality is Health care quality is suboptimal and suboptimal and

continues to improve continues to improve at a slow paceat a slow pace

Released May 6, 2009Released May 6, 2009

Annual Median Rate of Annual Median Rate of ChangeChange

Median annual Median annual rate of change for rate of change for the 45 core the 45 core measures = 1.8%measures = 1.8%

Highest rate of Highest rate of improvement improvement (2.5%) in (2.5%) in measures related measures related to acute treatmentto acute treatment

n = number of measures

Variation in Quality Variation in Quality

Receipt of care varies widely:Receipt of care varies widely:– Patients hospitalized with a heart attack Patients hospitalized with a heart attack

receive 95% of recommended servicesreceive 95% of recommended services

– Only 15% of patients on dialysis are Only 15% of patients on dialysis are registered on a kidney transplant waiting registered on a kidney transplant waiting listlist

Across report measures, the median Across report measures, the median level of receipt of needed care was 59%level of receipt of needed care was 59%

Hospital Quality Leading Hospital Quality Leading ImprovementImprovement

Median annual rate Median annual rate of change for of change for hospital measures hospital measures twice the rate for all twice the rate for all measures measures

Lowest rate for Lowest rate for ambulatory care ambulatory care measures, but at measures, but at least some least some improvement in improvement in 75% of these 75% of these measures measures

n = number of measures

Patient Safety LaggingPatient Safety Lagging

Safety Safety measures only measures only area to show area to show an overall an overall decline, with decline, with only 45% of the only 45% of the measures measures showing at showing at least some least some improvement improvement (17 out of 38)(17 out of 38)

n = number of measures

Health Care Quality Health Care Quality Measurement EvolvingMeasurement Evolving

GoalsGoals– Address emerging issuesAddress emerging issues

– Coordinate measure developmentCoordinate measure development

– Enable health information technology to Enable health information technology to support quality improvementsupport quality improvement

– Promote data standardization Promote data standardization

Origin of NHQROrigin of NHQR

Health and Human Services Health and Human Services Secretary required to submit Secretary required to submit annual report to Congress:annual report to Congress:

– National trends in health care National trends in health care quality (National Healthcare quality (National Healthcare Quality Report, or NHQR)Quality Report, or NHQR)

– Prevailing disparities in Prevailing disparities in health care delivery as it health care delivery as it relates to racial factors and relates to racial factors and socioeconomic factors in socioeconomic factors in priority populations (National priority populations (National Healthcare Disparities Healthcare Disparities Report, or NHDR)Report, or NHDR)

Mandated by Congress in Mandated by Congress in Healthcare Research and Healthcare Research and Quality Act (PL. 106-129)Quality Act (PL. 106-129)

NHQR and NHDR GoalsNHQR and NHDR Goals

Provide a snapshot of health care deliveryProvide a snapshot of health care delivery

– 45 core measures of quality and access45 core measures of quality and access

– 220 total measures220 total measures

Indicate the biggest gaps in careIndicate the biggest gaps in care

Show national and State trendsShow national and State trends

Tell us how we can reach our goals Tell us how we can reach our goals

Help align measures across public and private Help align measures across public and private quality initiativesquality initiatives

NHQR and NHDR FrameworkNHQR and NHDR Framework

Consumer Consumer Perspectives on Perspectives on

Health Care NeedsHealth Care Needs Components of Health Care QualityComponents of Health Care Quality

   SafetySafety EffectivenessEffectivenessPatient Patient

CenterednessCenteredness TimelinessTimeliness

Staying healthyStaying healthy            

Getting betterGetting better            

Living with illness or Living with illness or disabilitydisability            

Coping with end-of-Coping with end-of-life matterslife matters            

Source:Source: Institute of Medicine Committee. “Envisioning the National Health Care Quality Institute of Medicine Committee. “Envisioning the National Health Care Quality Report,” 2001Report,” 2001

Relationship Between Relationship Between NHQR and NHDRNHQR and NHDR

NHQRNHQR NHDRNHDRSnapshot of quality of Snapshot of quality of health care in Americahealth care in America

Snapshot of disparities Snapshot of disparities in health care in Americain health care in America

QualityQuality Quality + accessQuality + accessSafety, effectiveness, Safety, effectiveness, timeliness, patient timeliness, patient centerednesscenteredness

Safety, effectiveness, Safety, effectiveness, timeliness, patient timeliness, patient centeredness + equitycenteredness + equity

Variation across StatesVariation across States Variation across Variation across populationspopulations

NHQR/NHDR Content and NHQR/NHDR Content and OrganizationOrganization

Effectiveness Effectiveness – Cancer Cancer – Diabetes Diabetes – End Stage Renal Disease (ESRD) End Stage Renal Disease (ESRD) – Heart Disease Heart Disease – HIV and AIDS HIV and AIDS – Maternal and Child Health Maternal and Child Health – Mental Health and Substance AbuseMental Health and Substance Abuse– Nursing Home, Home Health, Nursing Home, Home Health,

and Hospice Care and Hospice Care Patient SafetyPatient Safety Timeliness Timeliness Patient Centeredness Patient Centeredness Access to Health Care Access to Health Care Priority PopulationsPriority Populations

*Also includes a chapter on Efficiency*Also includes a chapter on Efficiency

NHQR*NHDR

New in the 2008 NHQRNew in the 2008 NHQR

Chapter 2: Chapter 2: – Heart disease: Analysis of counseling obese adults about Heart disease: Analysis of counseling obese adults about

healthy eatinghealthy eating– Mental health: New measure on receipt of minimally Mental health: New measure on receipt of minimally

adequate treatment by adults with mental disordersadequate treatment by adults with mental disorders– Respiratory disease: New measure on daily preventive Respiratory disease: New measure on daily preventive

medicine use for current asthmamedicine use for current asthma– Hospice care: New measure on caregivers’ perception of Hospice care: New measure on caregivers’ perception of

referral to hospice at the right timereferral to hospice at the right time

Chapter 3: Additional patient safety measuresChapter 3: Additional patient safety measures Chapter 6: New measure on rehospitalizations for Chapter 6: New measure on rehospitalizations for

congestive heart failurecongestive heart failure

For more information…For more information…

NHQR and NHDR Web page NHQR and NHDR Web page http://www.ahrq.gov/qual/qrdr08.htmhttp://www.ahrq.gov/qual/qrdr08.htm

NHQRDRnet for data tables and queriesNHQRDRnet for data tables and queries

http://nhqrnet.ahrq.gov/nhqr/jsp/nhqr.jsphttp://nhqrnet.ahrq.gov/nhqr/jsp/nhqr.jsp

Request a copy (AHRQ publication no. 09-0001) Request a copy (AHRQ publication no. 09-0001) from AHRQ Publications Clearinghouse from AHRQ Publications Clearinghouse

1-800-358-9295 or 1-800-358-9295 or AHRQPubs@ahrq.hhs.govAHRQPubs@ahrq.hhs.gov