'Suboptimal care'

The news from the federal government's latest companion reports on healthcare quality and disparities mirrored the findings of past versions: Quality is improving, albeit slowly, but persistent racial, ethnic and economic disparities show little improvement.

Released annually since 2003 by HHS' Agency for Healthcare Research and Quality, the reports draw on a wide range of data—more than 40 sources for these latest reports—to make conclusions about healthcare system quality and gaps in care. The reports cover 2002 through 2008, with some data from 2009.

The quality report showed an overall median improvement of 2.5% across the healthcare system, about the same rate of change reported in previous years.

“The major takeaways are very similar to what we have shown in the past,” said Dr. Ernest Moy, medical officer in AHRQ's Center for Quality Improvement and Patient Safety. “Quality of care continues to be suboptimal. It does improve over the vast number of measures, but the rate of improvement is variable and it is much slower than we would want.”

The news from the disparities report was even bleaker, Moy said. Of the measures used to track disparities in healthcare access, roughly half showed no improvement and 40% showed a decline. Asians, American Indians and Alaska Natives received worse care than whites for 30% of the clinical quality measures in the report, and that number jumped to 41% for black patients.

Reducing disparities requires better access to care, active engagement from patients and tailored interventions that target specific populations, Moy says.

In an April 20 news release announcing the reports, AHRQ Director Dr. Carolyn Clancy predicted that the provisions of the healthcare reform law would help to ensure more equitable care. Moy agreed, but he added that the effects of the law would not be apparent in the reports for several years.

Moy said the data in this year's and next year's reports will serve as a baseline measure of the healthcare system before the reform law's policies begin to roll out.

“First, we'll begin to see improvements in the rates of uninsured, and then later, hopefully, in access to care,” he said. “Later, we envision improvements in quality of care and then, even further down the road, improvements in health outcomes. This is over the long term.”

Moy refused to speculate about the outcome of the pending legal challenges to the healthcare reform law, but he did express optimism that momentum toward improvement is growing regardless of the U.S. Supreme Court's decision.

“We're moving into an era when providers and patients increasingly accept the notion that we have to pay attention to quality and disparities,” Moy said. “No matter what happens from a legal perspective, that is not going to change.”

This year, AHRQ used HHS' National Quality Strategy as a framework for highlighting trends in the data. Unveiled in March 2011, the NQS identified six top priorities, including safer care, increased patient-centeredness, care coordination and affordability. In a 2011 news release, HHS said the strategy would function as “an evolving guide for the nation as we continue to move forward with efforts to measure and improve health and healthcare quality.”