# Presentation: 337924

## The Role of the NHQR and the NHDR in Improving the Quality of Health Care 

**Edward Kelley, Ph.D.**
- 	Director, National Healthcare Quality Report
- 	Center for Quality Improvement and Patient
- 		Safety
- 	Agency for Healthcare Research and Quality
- 	U.S. Department of Health and Human
- 		 Services
- 	Rockville, MD

## Background

- Mandated by Congress in the Healthcare
- Research and Quality Act (PL. 106-129)
- “Beginning in fiscal year 2003, the Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of health care provided to the American people.”

## Why Do We Need a National Report? 

- “Chasm” between actual and ideal performance in the U.S. health care system
- Overwhelming amount of health care information available to doctors/patients, yet lack of useable quality information
- Consumers care about quality and are increasingly demanding more information

**Notes:**
Amount of healthcare information available to doctors and patients overwhelming - 

## NHQR-DR Summary (1)

- 37 of 57 areas with trend data presented in the NHQR show no improvement or have deteriorated
- Fewer than one in five people with hypertension have it under control
- About one in five elderly Americans prescribed inappropriate/potentially harmful medications

_**High quality health care is not a given in the U.S. health care system.**_

## NHQR-DR Summary (2)

- Blacks and Hispanics — score lower than whites on about half of quality measures
- Hispanics and Asians — score lower than whites on about two-thirds of access measures
- Poor people — score lower on about two-thirds of quality and access measures

_**Gaps in health care quality are particularly acute for certain racial, ethnic, and socioeconomic groups.**_

## NHQR-DR Summary (3)

- Only 40% of people get smoking cessation counseling  in the hospital. Only 60% get counseling during office visits
- Black, Hispanic, poor adults—less likely to receive colorectal and breast cancer screening, influenza immunization
- Black, Hispanic,American Indian women—less likely to receive prenatal care
- Black, Hispanic, poor children— less likely to receive dental care
- Black, Hispanic, poor elderly—less likely to receive pneumococcal vaccination

_**Quality and disparity gaps are worse in preventive services.**_

## NHQR-DR Summary (4)

- Use of beta-blockers for heart attack patients rose from 21% of eligible patients in the early 1990s to 79%. 45 States are at or above 70% on this measure**.**
- 70% of women over 40 get mammograms for breast cancer. This exceeds Healthy People 2010 objective.
- Black women have higher screening rates for cervical cancer. Death rates among black women are falling at twice the rate as white women.
- Quality improvement efforts have resulted in reductions in black-white differences in hemodialysis.

**Percent of AMI patients prescribed a beta blocker at discharge by State**

_**Improvement in quality and disparities is possible.**_

## How the Reports Fit into AHRQ’s Focus on Implementation

_**Purpose of the Reports**_:
- To promote *awareness* of the status of health care quality and disparities in America; and
- To lead to *action* and support AHRQ’s overall mission “to improve the quality... of health care for all Americans.”

## From Knowing to Doing:  Implementing the NHQR-DR

## NHQR Conceptual Framework

## State Data in the NHQR

- Behavioral Risk Factor Surveillance System
- Medicare Quality Improvement Organizations (QIO) Program
- Minimum Data Set (CMS nursing home data)
- National CAHPS® Benchmarking Database
- National Immunization Survey
- Outcome and Assessment Information Set (OASIS; CMS home health data)
- United States Renal Data System
- University of Michigan Kidney Epidemiology and Cost Center (ESRD data)
- Vital Statistics

## Purpose

Provide overview of factors affecting quality of care for diabetes
Present core elements of health care quality improvement
Provide best practices/policy approaches on diabetes quality improvement from national organizations, State and Federal governments 
Help State policy makers/health care leaders use NHRQ data to plan State-level quality improvement initiatives

- Provide overview of factors affecting quality of care for diabetes
- Present core elements of health care quality improvement
- Provide best practices/policy approaches on diabetes quality improvement from national organizations, State and Federal governments
- Help State policy makers/health care leaders use NHRQ data to plan State-level quality improvement initiatives

**A Workbook for Crossing the Quality Chasm in Health Care: A State Leader’s Guide to Diabetes Care, ****Quality, Improvement**

## A Workbook for Crossing the Quality Chasm in Health Care: A State Leader’s Guide to Diabetes Care, Quality, Improvement

_**Audience**_
**State elected leaders**—governors, legislators and staff actively involved in health issues
**State executive branch officials**—State health department, Medicaid and State employee benefits administrators and staff
**Non-governmental State and local health care leaders**—members of professional societies, provider associations, quality improvement organizations, voluntary health organizations, health plans, business coalitions, etc.

## How Do I Use The Report Data? Example From The Chasm Workbook

**State 1 is better than the national norm in terms of HbA1c testing, but has room for improvement. **(See Figure 8 below.)** **The percent of adults with diabetes in State 1 who have this test (70.5 percent) is nine points higher than the national average and the difference is statistically significant, indicating that State 1 is more successful in this regard than the typical State in the nation.  However, compared to the States with the highest rates (“best in class” States), State 1 has some room for improvement.  The average of the top decile of States is 82.3 percent of adults with diabetes receiving an HbA1c test.

## For Further Information  

- AHRQ’s web site for the NHQR and NHDR:
- _[www.qualitytools.ahrq.gov](http://www.qualitytools.ahrq.gov/)_
- Contact information:
- Dr. Ed Kelley
- Director, National Healthcare Quality Report
- Agency for Healthcare Research and Quality
- 540 Gaither Road, Suite 300
- Rockville, MD  20850
- 301-427-1321(phone)
- 301-427-1341 (fax)
- (_[ekelley@ahrq.gov](mailto:ekelley@ahrq.gov)__)_