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

Quality and Disparities in Quality of Health Care

Measures of health care quality tracked in the QDR encompass a broad array of services, including prevention, emergency treatment, behavioral health care, and chronic disease management; and settings, including doctors’ offices, health centers, emergency departments, dialysis centers, hospitals, mental health and substance use treatment facilities, nursing homes, hospices, and home health. Most QDR quality measures quantify processes that make up high-quality health care or outcomes related to receipt of high-quality health care. A few structural measures are included, such as the availability of health information technologies and diverse workforces.

Data used to generate QDR measures include results from more than three dozen datasets that provide estimates for various population subgroups and data years. Most data are reported annually and are generally available through 2013. Sources used to assess health care quality in the reports include:

  • Surveys of patients, patients’ families, and providers.
  • Administrative data from health care facilities and home health agencies.
  • Abstracts of clinical charts.
  • Registry data.
  • Vital statistics.

Historically, quality of health care has varied based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location. As specified in the Healthcare Research and Quality Act in 1999, this summary focuses on disparities related to race and socioeconomic status.

With the passage of the Affordable Care Act in 2010, the Department of Health and Human Services (HHS) was charged with identifying national priorities and developing and implementing a National Quality Strategy to achieve better care, healthy people/healthy communities, and affordable care. This section presents summary data across the six National Quality Strategy priorities that address the most common health concerns that Americans face. The following section provides more detail about each National Quality Strategy priority.

Quality of health care improved generally through 2013, but the pace of improvement varied by the NQS priority.

Number and percentage of all quality measures that are improving, not changing, or worsening through 2013, overall and by NQS priority

Bar graph shows number and percentage of all quality measures that are improving, not changing, or worsening through 2013. Text description is below the image.

Quality Measures Improving No Change Worsening
Total (n=191) 110 62 19
Person-Centered Care (n=20) 16 3 1
Patient Safety (n=31) 19 10 2
Healthy Living (n=58) 35 18 5
Effective Treatment (n=37) 21 13 3
Care Coordination (n=37) 18 13 6

Key: n = number of measures.

Note: For the majority of measures, trend data are available from 2001 to 2013. Measures of Care Affordability are included in the Total but not shown separately.

For each measure with at least four estimates over time, log-linear regression is used to calculate average annual percentage change relative to the baseline year and to assess statistical significance. Measures are aligned so that positive change indicates improved care.

  • Improving = Rates of change are positive at 1% per year or greater and are statistically significant.
  • No Change = Rates of change are less than 1% per year or not statistically significant.
  • Worsening = Rates of change are negative at -1% per year or greater and are statistically significant.
  • Through 2013, across a broad spectrum of measures of health care quality, about 60% showed improvement.
  • Eighty percent of measures of Person-Centered Care improved.
  • About 60% of measures of Effective Treatment, Healthy Living, and Patient Safety improved.
  • Fewer than half of measures of Care Coordination improved.
  • Fewer than a dozen measures of Care Affordability are tracked in the report, too few to summarize in this way.

Quality Disparities persist, especially among people in poor households, Hispanics, and Blacks.

Number and percentage of quality measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group

Bar graph shows number and percentage of quality measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group. Text description is below the image.

Quality Poor vs. High Income (n=147) Hispanic vs. White (n=210) Black vs. White (n=248) Asian vs. White (n=217)  AI/AN vs. White (n=142)
Better 7 44 30 71 18
Same 52 89 116 102 78
Worse 88 77 102 44 46

Key: AI/AN = American Indian or Alaska Native; n = number of measures.

Note: Numbers of measures differ across groups because of sample size limitations. The relative difference between a selected group and its reference group is used to assess disparities. For income, the reference group is High Income. For race and ethnicity, the reference group is White.

  • Better = Population received better quality of care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
  • Same = Population and reference group received about the same quality of care. Differences are not statistically significant or are smaller than 10%.
  • Worse = Population received worse quality of care than reference group. Differences are statistically significant, equal to or larger than 10%, and favor the reference group.
  • People in poor households received worse care than people in high-income households for about 60% of quality measures (green).
  • Blacks, Hispanics, and American Indians and Alaska Natives received worse care than Whites for about 40% of quality measures.
  • Asians received worse care than Whites for about 20% of quality measures.
  • For each group, disparities in quality of care are similar to disparities in access to care, although disparities in access tend to be more common than disparities in quality.
  • Disparities also varied across NQS priorities.
    • Disparities were more common among measures of Person-Centered Care and Care Coordination, involving about 60% of comparisons (data not shown).
    • Disparities were less common among measures of Patient Safety, Effective Treatment, and Healthy Living, involving about 30% of comparisons (data not shown).

Some Quality Disparities are getting smaller, but many are not improving across a broad spectrum of quality measures.

Number and percentage of quality measures with disparity at baseline for which disparities related to race, ethnicity, and income were improving, not changing, or worsening through 2013

Bar graph shows number and percentage of quality measures with disparity at baseline for which disparities related to race, ethnicity, and income were improving, not changing, or worsening. Text description is below the image.

Quality Poor vs. High Income (n=87) Hispanic vs. White (n=64) Black vs. White (n=80) Asian vs. White (n=26)  AI/AN vs. White (n=23)
Improving 29 28 37 8 5
No Change 53 33 37 18 17
Worsening 5 3 6   1

Key: AI/AN = American Indian or Alaska Native; n = number of measures.

Note: Numbers of measures differ across groups because of sample size limitations. For the majority of measures, trend data are available from 2001 to 2013. For each measure with a disparity at baseline in which the group of interest received worse care than the reference group, average annual percentage changes were calculated for select populations and reference groups. For income, the reference group is High income. For race and ethnicity, the reference group is White. Measures are aligned so that positive rates indicate improvement in care. Differences in rates between groups were used to assess trends in disparities. Measures with no disparity at baseline are excluded.

  • Worsening = Disparities are getting larger. Differences in rates between groups are statistically significant and rates for the reference group exceed rates for the groups of interest by at least 1% per year.
  • No Change = Disparities are not changing. Differences in rates between groups are not statistically significant or differ by less than 1% per year.
  • Improving = Disparities are getting smaller. Differences in rates between groups are statistically significant and rates for the groups of interest exceed rates for the reference group by at least 1% per year.
  • Through 2013, about 40% of disparities at baseline for Blacks, Hispanics, and people in poor households were getting smaller. Nearly  one-third of disparities for Asians were getting smaller.
  • About 20% of disparities at baseline for American Indians and Alaska Natives were getting smaller.
  • Disparities that were getting smaller included 24 measures in which a disparity at baseline was eliminated (9% of disparities at baseline), primarily affecting Blacks and Hispanics.
  • There were also 16 measures in which a disparity was not present at baseline but developed over time (4% of contrasts in which there was not a disparity at baseline), primarily affecting Asians (data not shown).
  • Change in disparities over time also varied across NQS priorities.
    • About 45% of disparities related to Care Coordination and Effective Treatment were getting smaller (data not shown).
    • Only about 30% of disparities related to Patient Safety, Person-Centered Care, and Healthy Living were getting smaller (data not shown).

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Page last reviewed May 2016
Page originally created May 2016
Internet Citation: Quality and Disparities in Quality of Health Care. Content last reviewed May 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/quality.html