Quality Is Improving in Many Areas, But Change Takes Time

Health care quality was largely unchanged between the 2003 report and the 2004 report. However, in many areas of health care delivery, improvements were seen in specific measuresⁱ:

• Out of 98 measures with trend dataⁱⁱ, most measures have shown some improvement. Overall, over twice as many measures have improved (67) as have deteriorated (30). One measure showed no change.
• Twelve measures improved between 5% and 10% and 15 measures improved between 10% and 20% (Figure H.1).
• Across the 98 measures, health care quality improved by a median value of 2.8% between data for the reference year shown in the 2003 report and data for the latest year shown in the 2004 reportⁱⁱⁱ.
• Major change takes time in national quality measurement. Half of the 98 measures with trend data show modest (between -5% and +5%) or no change.

Figure H.1. Number of measures that have deteriorated or improved, 2003 NHQR vs. 2004 NHQR

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• The accumulation of multiple years of data will allow future reports to present a more accurate picture of the national direction in health care quality, as trends for shorter periods of time are difficult to interpret.
• Most trend measures are in the effectiveness areas. Although positive change occurred throughout the measure set, most of the changes were seen in effectiveness (Figure H.2).
• Levels of change in performance in the measures with trend data varied somewhat across care settings. Of the 98 measures with trend data, 90 measures could be mapped to care settings^iv.
  • For the 49 measures of ambulatory care quality, performance improved by a median change of 1.4%.
  • For the 24 measures of hospital care quality, performance improved with a median change of 5.4%.
  • For the 12 measures of home health care quality, performance was virtually unchanged with a median change of 3%.
  • For the 5 measures of nursing home quality, performance improved by a median change of 14.7%.

Figure H.2. Change in quality by health care component, 2003 NHQR vs. 2004 NHQR

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Note: Excludes one overall measure.

ⁱThe representation of measure change in Figure H.1 tracks absolute change in these measures where trend data are available. The chart shows the full distribution of "change" in quality within the measure set; no statistical restrictions were used in judging the level of change. Information on statistical testing done for measures in other chapters of this report is presented in Chapter 1. This approach is consistent with measure summary approaches used in the Healthy People 2000 Final Review¹. New methodologies are proposed for measuring progress in HP2010² and developmental work on summary measures is underway at AHRQ. Future reports will reflect new approaches to the reporting of summary measures as they become available.

ⁱⁱThis includes measures in all of the four dimensions of quality (effectiveness, safety, timeliness, and patient centeredness). However, because of measure specification changes, only two measures of safety are included in this trend analysis. In addition, trend data for one HIV measure and one heart disease measure have been excluded from this analysis because of data changes over time.

ⁱⁱⁱPercent improvement is computed as the median change across all 98 measures for which trend data are available. Median change was computed by taking the percent change from the 2003 NHQR data to the 2004 NHQR data and taking the median value for the 98 measures with trend data.

^ivChange is defined as the median average change across measures with trend data between the 2003 NHQR and 2004 NHQR. Detailed information on the exact measures included in these calculations is presented in the Summary Measures section of the Measure Specifications Appendix.

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