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Quality and Disparities: Delivering Patient-Centric Care


Carolyn M. Clancy, M.D.
Director
Agency for Healthcare Research and Quality

Two reports recently released by the Agency for Healthcare Research and Quality (AHRQ) demonstrate that the number of patients who do not receive appropriate treatment remains high. In fact, for certain services, recommended care is delivered only about half the time. We are striving to understand these variances—both their nature and their reasons. We know that these gaps exist despite focused, collaborative national and regional efforts to improve the quality of health care.

In fact, overall quality is improving, as the 2006 National Healthcare Quality Report and National Healthcare Disparities Report demonstrate. Even so, the evidence is clear that much more can be done. It is clear that we are missing opportunities to provide patient-centric care all the time. Refocusing our system—by reducing variability and improving quality for all, placing the patient at the center of the system—should be our nation’s highest health care priority.

The Data Show Improvement
The National Healthcare Quality Report, published and presented to Congress in January 2007, tracks quality measures for the health care system, such as what proportion of heart attack patients receive recommended care when they arrive at a hospital. Its companion, the National Healthcare Disparities Report, summarizes gaps in quality of care and access to care for racial, ethnic, and income groups. These two reports—the fourth annual reports—are published together because it is important to track overall health care quality improvement simultaneously with the disparities that continue to plague our health care system.

According to the data, areas in which there have been intensive national efforts to improve the quality of care have seen very significant quality improvements. I believe that these improvements are directly attributable to initiatives sponsored by the Department of Health and Human Services’ Centers for Medicare and Medicaid Services, which has worked with Hospital Quality Alliance and other stakeholders to foster appropriate and timely care and to provide quality measurement information to consumers.

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Yet, providers are still missing important opportunities to help Americans avoid disease or serious complications. Of particular concern, the use of proven prevention strategies lags significantly behind other gains in health care.

As the National Healthcare Disparities Report reveals, access to and quality of care vary widely among racial, ethnic, and economic groups. Unfortunately, minority populations tend to receive poorer quality care.

Conclusions to Draw
The reports characterize two major health care public policy challenges—to improve the quality of health care, and to make sure that no communities or populations are left behind in our quality improvement efforts.

The reports’ comprehensive data also suggest that, even at state and national levels, quality improvement works. Sustained focus, public reporting, and active and persistent interventions make a significant difference in the quality of health care, especially in the areas of patient safety and hospital processes.

Finally, these reports give us direction as to where we should aim our quality efforts, and the trends tracked over the last four years of reports help us to measure how we are doing. A focus on preventive services would benefit all patients, particularly minority patients.

Delivering Patient-Centric Care
The hundreds of millions of annual health care encounters comprise one large opportunity—to improve the overall quality of health care across the board, with the patient at the center of the improvement process. In an effort to improve those encounters, AHRQ has joined with The Advertising Council to launch a national public service advertising campaign designed to encourage adults to take a more proactive role in their health care. The “Questions Are the Answer: Get More Involved With Your Health Care” campaign encourages all patients and caregivers to become more active in their health care by asking questions.

The health care quality improvement movement has matured during this decade, but it still remains in its infancy. We need to continue to study quality shortcomings and disparities, and to allow the data to drive our quality improvement efforts.

Links to the Reports

• National Healthcare Quality Report, 2006. Agency for Healthcare Research and Quality, Rockville, MD. www.ahrq.gov/qual/nhqr06/nhqr06.htm
  


• National Healthcare Disparities Report, 2006. Agency for Healthcare Research and Quality, Rockville, MD. www.ahrq.gov/qual/nhdr06/nhdr06.htm