The National Healthcare Quality and Disparities Report (QDR) continues to track the nation’s performance on health care access, quality, and disparities. The QDR data demonstrate significant progress in some areas and identify other areas that merit more attention where wide variations persist. The number of measures in each priority area varies, and some measures carry more significance than others as they affect more people or have more significant consequences. But the numbers below are a way to quantify and illustrate progress toward achieving accessible, high-quality and affordable care at the national level using the available nationally representative data.
This report shows that while the performance for most access measures did not change significantly over time (2000-2014), the insurance coverage rates did improve (2000-2016). Quality of health care improved in most areas but some disparities still persist, especially for poor and low-income households and those without health insurance.
U.S. Department of Health and Human Services (HHS) agencies are working on research and conducting programs in many of the priority areas, most notably:
- Patient Safety. The National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015 showed a 21 percent decline in hospital-acquired conditions, due to hospitals’ increased focus on safety, spurred in part by Medicare payment incentives and catalyzed by the HHS Partnership for Patients initiative. Future improvements in patient safety are expected as ambulatory settings focus on improving patient safety. A new AHRQ resource, Toolkit To Improve Safety in Ambulatory Surgery Centers, helps ambulatory surgery centers (ASCs) make care safer for their patients. ASCs can use the toolkit to apply the proven principles and methods of AHRQ’s Comprehensive Unit-based Safety Program (CUSP) to prevent surgical site infections and other complications and improve safety culture in their facilities. In addition, new CUSP toolkits are available on the AHRQ Web site to help clinicians and hospitals reduce ventilator-associated events and to help nursing home staff reduce catheter-associated urinary tract infections.
Effective Treatment and Care Coordination for mental health and substance use treatment. The Surgeon General’s Report on Alcohol, Drugs, and Health reviews the knowledge base of substance use and provides recommendations to address substance misuse and related health consequences.
Since 2009, the SAMHSA-HRSA Center for Integrated Health Solutionsiv has provided resources for integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions or comorbidities of mental and substance use disorders. Integrating mental health, substance use disorder treatment, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple health care needs.
The SAMHSA Knowledge Application Program provides substance use treatment professionals with publications, online education, and other resources that contain information on best treatment practices.
National Institutes of Health/National Institute of Mental Health funding opportunities such as PAR-17-265 encourage research applications to develop and test the effectiveness and implementation of family navigator models designed to promote early access, engagement, and coordination of mental health treatment and services for children and adolescents who are experiencing early symptoms of mental health problems.
In addition, HHS continues to address health disparities. New data and resources address health disparities, especially among racial and ethnic minorities, older populations, rural populations, and people with limited English proficiency. One recent report is Racial and Ethnic Disparities by Gender in Health Care in Medicare Advantage from the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health.
Although the QDR does not include data on veterans, data are available from the Department of Veterans Affairs (VA). The Office of Health Equity has conducted research and published the National Veteran Health Equity Report, which showed burden of diseases for veterans.
Project ECHO (Extension for Community Healthcare Outcomes) is a notable program addressing health disparities jointly funded by several HHS agencies, including AHRQ, CDC, CMS, HRSA, and SAMHSA, as well as other federal and state government agencies and private partners. It is a collaborative model of medical education and care management to increase access to specialty treatment in rural and underserved areas by engaging clinicians in a continuous learning system and partnering them with specialist mentors at an academic medical center or hub.
Recently, the National Institute on Minority Health and Health Disparities launched a new resource for stakeholders who work with populations with limited English proficiency: the Language Access Portal (LAP). The LAP contains information in multiple languages on diseases for which major health disparities have been identified in non-English-speaking populations, including cancer, diabetes, and cardiovascular disease. New disease areas will continue to be included and additional resources will be incorporated as they become available.
The Office of the National Coordinator for Health IT (ONC) Health IT Certification Program supports the availability of certified health IT for its encouraged and required use under federal, state, and private programs. The Health IT Certification Criteria (2015 Edition) includes certification criteria that support the capture of a wider range of patient health information, in a structured, more granular way. These criteria can help clinicians and organizations identify opportunities for care improvement for the patient populations they serve. It is a critical step forward in addressing health disparities in our health care system and in supporting quality care for all people, regardless of race, gender, sexual orientation, socioeconomic background, or behavioral conditions.
The Centers for Disease Control and Prevention provides ongoing administrative, scientific, and technical support for the operations of the Community Preventive Services Task Force whose members review the effectiveness of intervention approaches across a wide range of health topics, including health equity. The Guide to Community Preventive Services (The Community Guide) is a collection of evidence-based findings of the Task Force applicable to communities, and other populations. It includes strategies such as health care system changes, workplace and school programs and policies, and community-based programs.
Through various quality improvement and patient safety initiatives, HHS and other federal agencies drive us toward better health care. The 2016 QDR documents ongoing progress toward the goal of high-quality health care that is accessible to all Americans and identifies areas for improvement. Policymakers, researchers, and others can use these findings to direct future efforts toward making health care more coordinated, affordable, and equitable.