2014 National Healthcare Quality & Disparities Report

Executive Summary

The National Healthcare Quality and Disparities Reports are annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). These reports provide a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The purpose of the reports is to assess the performance of our health system and to identify areas of strengths and weaknesses in the health care system along three main axes: access to health care, quality of health care, and priorities of the National Quality Strategy (NQS).

The reports are based on more than 250 measures of quality and disparities covering a broad array of health care services and settings. Data are generally available through 2012, although rates of uninsurance have been tracked through the first half of 2014. The reports are produced with the help of an Interagency Work Group led by the Agency for Healthcare Research and Quality (AHRQ) and submitted on behalf of the Secretary of Health and Human Services (HHS).

Beginning with this 2014 report, findings on health care quality and health care disparities are integrated into a single document. This new National Healthcare Quality and Disparities Report (QDR) highlights the importance of examining quality and disparities together to gain a complete picture of health care. This document is also shorter and focuses on summarizing information over the many measures that are tracked; information on individual measures will still be available through chartbooks posted on the QDR Web site (http://nhqrnet.ahrq.gov).

The new QDR and supporting chartbooks are further integrated with the NQS. The NQS has three overarching aims that build on the Institute for Healthcare Improvement's Triple Aim® and that support HHS’s delivery system reform initiatives to achieve better care, smarter spending, and healthier people through incentives, information, and the way care is delivered. These aims are used to guide and assess local, state, and national efforts to improve health and the quality of health care. To advance these aims, the NQS focuses on six priorities that address the most common health concerns that Americans face. Quality measures tracked in the QDR have been reorganized around these priorities and a chartbook will be released marking progress for each NQS priority.

Key Findings of the 2014 Quality and Disparities Report

The report demonstrates that the nation has made clear progress in improving the health care delivery system to achieve the three aims of better care, smarter spending, and healthier people, but there is still more work to do, specifically to address disparities in care.

  • Access improved.
    • After years without improvement, the rate of uninsurance among adults ages 18-64 decreased substantially during the first half of 2014
    • Through 2012, improvement was observed across a broad spectrum of access measures among children.
  • Quality improved for most NQS priorities.
    • Patient Safety improved, led by a 17% reduction in rates of hospital-acquired conditions between 2010 and 2013, with 1.3 million fewer harms to patients, an estimated 50,000 lives saved, and $12 billion in cost savings.
    • Person-Centered Care improved with large gains in patient-provider communication.
    • Many Effective Treatment measures, including several measures of pneumonia care in hospitals publicly reported by the Centers for Medicare & Medicaid Services (CMS), achieved such high levels of performance that continued reporting is unnecessary.
    • Healthy Living improved, led by doubling of selected adolescent immunization rates from 2008 to 2012.
  • Few disparities were eliminated.
    • People in poor households generally experienced less access and poorer quality.
    • Parallel gains in access and quality across groups led to persistence of most disparities.
    • At the same time, several racial and ethnic disparities in rates of childhood immunization and rates of adverse events associated with procedures were eliminated, showing that elimination is possible.
  • Many challenges in improving quality and reducing disparities remain.
    • Performance on many measures of quality remains far from optimal. For example, only half of people with high blood pressure have it controlled. On average, across a broad range of measures, recommended care is delivered only 70% of the time.
    • As noted above, disparities in quality and outcomes by income and race and ethnicity are large and persistent, and were not, through 2012, improving substantially.
    • Some disparities related to hospice care and chronic disease management grew larger.
    • Data and measures need to be improved to provide more complete assessments of two NQS priorities, Care Coordination and Care Affordability, and of disparities among smaller groups, such as Native Hawaiians, people of multiple races, and people who are lesbian, gay, bisexual, or transgender.

Summary: Access and Access Disparities

  • After years without improvement, the rate of uninsurance among adults ages 18-64 decreased substantially during the first half of 2014.
  • During the first half of 2014, declines in rates of uninsurance were larger among Black and Hispanic adults ages 18-64 than among Whites, but racial differences in rates remained.
  • Through 2012, improvement was observed across a broad spectrum of access measures among children but less so among adults ages 18-64.
  • Through 2012, across a broad spectrum of access measures, some disparities were reduced but most did not improve.

Summary: Quality and Quality Disparities

  • Quality of health care improved generally through 2012, but the pace of improvement varied by measure.
  • Publicly reported CMS measures were much more likely than measures reported by other sources to achieve high levels of performance.
  • Disparities in quality of care remained prevalent and few disparities were eliminated.
  • Overall quality and racial/ethnic disparities varied widely across states, and often not in the same direction. Southern states tended to have poorer quality but smaller disparities while Middle Atlantic and West North Central states tended to have higher quality but larger disparities.

Summary: National Quality Strategy Priorities

  • The National Quality Strategy has six priorities: Patient Safety, Person-Centered Care, Care Coordination, Effective Treatment, Healthy Living, and Care Affordability.
  • Half of Patient Safety measures improved,i led by a 17% reduction in rates of hospital-acquired conditions.
  • Person-Centered Care improved steadily, especially for children.
  • Care Coordination improved as providers enhanced discharge processes and adopted health information technologies.
  • Effective Treatment in hospitals achieved high levels of performance, led by measures publicly reported by CMS on Hospital Compare.
  • Healthy Living improved in about half of the measures followed, led by selected adolescent vaccines from 2008 to 2012.
  • Care Affordability worsened from 2002 to 2010 and then leveled off.

i. We use "measures improved" as shorthand to indicate that performance on measures showed improvement and "measures got worse" as shorthand to indicate that performance on measures showed worsening.

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Page last reviewed April 2015
Page originally created April 2015
Internet Citation: Executive Summary. Content last reviewed April 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/exsumm.html