Diagnostics & Imaging Week

The Agency for Healthcare Research and Quality (Washington) has issued an overview report saying that “[t]he overall quality of the U.S. healthcare system is improving” — a statement open to debate — but then adds what few would disagree with.

It says that providers “are missing important chances to help Americans avoid disease or serious complications.”

The group’s annual reports, the 2006 “National Healthcare Quality Report” and the “National Healthcare Disparities Report,” say “the use of proven prevention strategies lags significantly behind other gains in healthcare.” Figures supporting this statement include:

Only about 52% of adults report receiving recommended colorectal cancer screenings. About 56,000 Americans die from colorectal cancer, and 150,000 new cases are diagnosed each year. In 2002, the AHRQ-supported U.S Preventive Services Task Force urged initial screenings at age 50 and earlier for people at high risk.

  • Fewer than half of obese adults report being counseled about diet by a healthcare professional. About one-third of American adults are obese, increasing the risks of high blood pressure, Type 2 diabetes, stroke, heart disease and osteoarthritis. (The Task Force recommends “intensive counseling and behavioral interventions” for obese adults.)
  • Only 49% of people with asthma say they were told how to change their environment, and 28% report receiving an asthma management plan. Asthma causes about 500,000 hospitalizations annually.
  • Only 48% of adults with diabetes received all three recommended screenings — blood sugar tests, foot exams and eye exams — to prevent complications. AHRQ estimates about $2.5 billion could be saved each year by eliminating hospitalizations related to diabetes complications.

Other figures support AHRQ’s contention that U.S. healthcare is improving in general:

  • A review of 40 core quality measures found a 3.1% increase in the quality of care — the same rate of improvement as the previous two years. Except for vaccinations for children, adolescents, and the elderly, which improved by almost 6%, the improvement rate for other preventive measures — screenings, advice, and prenatal care — was less than 2%.

The greatest quality gains occurred in U.S. hospitals, where quality improved 7.8%. For instance:

  • Ambulatory care — health services provided at doctors’ offices, clinics or other settings without an overnight stay — improved by 3.2%. Nursing home and home healthcare improved by 1%.
  • Hospital care for heart attack patients improved 15%. Hospital care for pneumonia patients improved 11.7%.
  • Steps taken to avoid complications after surgery improved 7.3%.

AHRQ analysts attributed the significant improvements in hospital care to initiatives sponsored by the Centers for Medicare & Medicaid Services.

While the “National Healthcare Quality Report” tracks the healthcare system through quality measures — such as what proportion of heart attack patients received recommended care when they reached the hospital — the “National Healthcare Disparities Report” summarizes which racial, ethnic or income groups are most likely to benefit from healthcare improvements. And, as in previous years, the disparities report found access to care varied widely between racial, ethnic and economic groups.

  • Blacks received poorer quality care than whites for 73% of the core measures included in the disparities report.
  • Hispanics received poorer quality of care than non-Hispanic whites for 77% of the measures.
  • Poor people received lower quality of care than high-income people for 71% of the measures.
  • The variations were particularly apparent in the area of prevention.

Obese blacks were less likely to be told they were overweight by their doctor or other healthcare provider. Colorectal cancer screening rates were significantly lower for blacks and Asians when compared with whites. Among people 65 and older, blacks, Hispanics and those in lower income groups were less likely to have ever received a vaccine to prevent pneumonia.