2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy

Aims of the National Quality Strategy

The National Quality Strategy pursues three broad aims that guide local, state, and national efforts to improve population health and the health care delivery system. The National Quality Strategy’s three aims closely resemble the Institute for Healthcare Improvement (IHI) Triple Aim® and build on the work that IHI has done by giving additional consideration to the health of communities at different levels and affordability for multiple groups. The three aims are:

  1. Better Care: Improve overall quality, by making health care more patient centered, reliable, accessible, safe, and focused on achieving meaningful health outcomes.
  2. Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and, environmental determinants of health in addition to delivering higher quality care.
  3. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

The health care system is highly complex. The scope of the challenge to achieve these three aims is illustrated in the figures in this section. Progress toward these aims is discussed in the sections that follow. Millions of health care workers in a variety of settings deliver billions of services each year. People experience mortality and morbidity from myriad ailments, necessitating the availability of specialized training, treatment, and technology. Trillions of dollars are spent each year on personal health care from a variety of public and private sources. An effective National Quality Strategy is needed to help coordinate stakeholders in support of the system as a whole.

Aim 1: Achieving Better Care requires coordinating services across a complex health care system. Health care employs millions of workers providing billions of services each year. Improving care requires facilities and providers to work together to expand access, enhance quality, and reduce disparities. Care delivered by providers in many types of health care settings is tracked in the QDR. While health is affected by many factors besides health care, receipt of appropriate high-quality services and counseling about healthy lifestyles can facilitate the maintenance of well-being and functioning.

Number of Health Care Services, United States, 2011

Bar chart shows numbers in health care services in millions: Physician office visits - 1008.802; Hospital outpatient visits - 754.454; Home health visits - 156.9768; Nursing home days - 505.604; Hospital days - 223.0465; Hospice days - 109.516.


  • In 2011, there were 1 billion physician office visits (including visits to physicians in health centers), 754 million hospital outpatient visits, and 157 million home health visits.
  • Patients spent 506 million days in nursing homes, 223 million days in hospitals, and 110 million days under hospice care.

Source: NCHS, Health, United States, 2014 (physician and hospital); NCHS, Long-term care services in the United States: 2013 overview (nursing home); MedPAC, June 2015 Data Book: health care spending and the Medicare Program (home health and hospice).

Number of People Working in Health Occupations, United States, 2014

Bar chart shows number of people in health occupations in thousands: Doctors of Medicine - 809; Dentists -193; Advanced practice nurses - 164; Registered nurses - 2,687; Therapists - 610; Pharmacists - 291; Other Health Practitioners - 333; EMTs - 233; Health Technologists - 2,642; Aides - 2,519; Other Health Occupations	1,422.


  • In 2011, there were 810,000 doctors of medicine and 190,000 dentists working in the United States.
  • They were joined by 2.7 million registered nurses, 2.6 million health technologists, and 2.5 million nursing and other aides in providing health care in 2014.

Key: EMT = emergency medical technicians and paramedics.
Source: NCHS, Health, United States, 2014 (doctors and dentists); and Bureau of Labor Statistics Occupational Employment Statistics, 2014 (all other occupations).

Note: Doctors of Medicine do not include Doctors of Osteopathic Medicine. Aides include nursing, psychiatric, home health, occupational therapy, and physical therapy assistants and aides.

Aim 2: Achieving Healthy People/Healthy Communities requires optimizing population health by mitigating the effects of the leading causes of morbidity and mortality. Care for most of these conditions is tracked in the QDR. Variation in care across communities contributes to disparities related to race, ethnicity, and socioeconomic status.

Leading Diseases Contributing to Years Lived With Disability (YLD), 2010

Bar chart shows leading diseases that contributing to years lived with disability (YLD) in thousands: Asthma - 932; Osteoarthritis - 994; Diabetes - 1164.9; Drug Use - 1295.5; COPD - 1745.4; Anxiety - 1866.1; Neck Pain - 2134.4; Other Musculoskeletal Disorder - 2602.5; Depressive Disorder - 3048.9; Low Back Pain - 3180.6.


  • The eight leading diseases and injuries contributing to YLDs (low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, anxiety disorders, chronic obstructive pulmonary disease, drug use disorders, and diabetes) did not change between 1990 and 2010.
  • From 1990 to 2010, there was a 56% increase in YLDs caused by osteoarthritis, moving its rank from number 12 to number 9.
  • From 1990 to 2010, YLDs caused by asthma only increased 21%, resulting in asthma moving down the ranking from number 9 to number 10.

Key: COPD = chronic obstructive pulmonary disease.
Source: The state of U.S. health, 1990-2010. Burden of diseases, injuries, and risk factors. U.S. Burden of Disease Collaborators. JAMA 2013;310(6):591-608. http://jama.jamanetwork.com/article.aspx?articleid=1710486.

Leading Cause of Death, 2013

Bar chart shows leading causes of death for 2013 (crude rate per 100,000): Suicide - 13; Kidney Disease - 14.9; Pneumonia and Flu - 18; Diabetes - 23.9; Alzheimer's Disease - 26.8; Cerbrovascular Disease - 40.8; Unintentional Injuries - 41.3; CLRD - 47.2; Cancer - 185; Heart Disease - 193.3.


  • Heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, cerebrovascular diseases, and diabetes were among the leading causes of death for all racial/ethnic groups.
  • The leading causes of death vary by race and ethnicity. For example, suicide was not a leading cause of death for Blacks and Hispanics, and Alzheimer’s disease was not a leading cause of death for American Indians and Alaska Natives.

Key: CLRD = chronic lower respiratory diseases.
Source: Xu J, Murphy SL, Kochanek KD, et al. Deaths: final data for 2013. Natl Vital Stat Rep 2016; 64(2). http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf (7.5 MB)


Aim 3: Achieving Affordable Care requires smarter spending of limited health care dollars. Health care is costly. Multiple sources of fragmented expenditures channeled to the various sectors of care is a challenge for controlling growth in health care costs. New delivery system models that coordinate care across sectors and that may help ensure that money is spent efficiently are highlighted in the QDR.

Personal Health Care Expenditures, by Type of Expenditure, 2013

Pie chart shows personal health care expenditures by type of expenditure: Hospital Care - 38.0%; Physician and Clinical Services - 23.8%; Prescription Drugs - 11.0%; Dental Services - 4.5%; Nursing Care - 6.3%; Other Health Care - 6.0%; Home Health Care - 3.2%; Durable Equipment - 1.7%.


  • In 2013, hospital care expenditures were $936.9 billion, 38% of personal health care expenditures.
  • Expenditures for physician and clinical services were $586.7 billion while expenditures for dental services were $111.0 billion, 24% and 4% of personal health care expenditures, respectively.
  • Prescription drug expenditures were $271.1 billion, 11% of personal health care expenditures.
  • Nursing care facility expenditures were $155.8 billion and home health care expenditures were $79.8 billion, or 6% and 3% of personal health care expenditures, respectively.

Source: CMS, National Health Expenditures Account, as reported in NCHS, Health, United States, 2014.

Personal Health Care Expenditures, by Source of Funds and Type of Expenditure, 2013

Pie chart shows personal health care expenditures by source of funds: Private insurance - 34.3%; Medicare - 22.3%; Medicaid - 16.6%; Out-of-pocket - 13.7%; Other Third Party - 9.0%; CHIP - 0.5%.

Source: CMS, National Health Expenditures Account, as reported in NCHS, Health, United States, 2014.
Note: Percentages do not add to 100 due to rounding.

  • In 2013, private insurance covered 34% of personal health care expenditures, followed by Medicare, Medicaid, and out of pocket.
  • Sources of funds varied by type of expenditure.
  • Private insurance was responsible for 37% of hospital, 46% of physician, 7% of home health, 8% of nursing home, and 44% of prescription drug expenditures.
  • Medicare was responsible for 26% of hospital, 22% of physician, 43% of home health, 22% of nursing home, and 28% of prescription drug expenditures.
  • Medicaid was responsible for 18% of hospital, 9% of physician, 37% of home health, 30% of nursing home, and 8% of prescription drug expenditures.
  • Out-of-pocket payments covered 4% of hospital, 9% of physician, 8% of home health, 29% of nursing home, and 17% of prescription drug expenditures.

Return to Contents

Page last reviewed June 2018
Page originally created May 2016
Internet Citation: Aims of the National Quality Strategy. Content last reviewed June 2018. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/aims.html
Back To Top