# Presentation: 103854

## Ernest Moy
Center for Quality Improvement and Patient Safety

- Center for Quality Improvement and Patient Safety

**National Healthcare Reporting: Quality and Disparities Reports**

**Notes:**
Can add subtitle as appropriate for your presentation

## Congressional Mandate

- 	Mandated by Congress in the Healthcare	Research and Quality Act (PL. 106-129)
- “National trends in the quality of health care provided to the American people”
- “Prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations”

## Paired Reports 

| NHQR | NHDR |
| --- | --- |
| Snapshot of quality of health care in America | Snapshot of disparities in health care in American |
| Quality | Quality + Access |
| Variation across states | Variation across populations |

## Linking Disparities & Quality

- Actual Care
- for the
- Disadvantaged

- Actual Care
- for the
- Advantaged

- Disparities Chasm

- Inequitable:
- Uninsurance,
- Poverty,
- Language,
- Culture,
- Bias

- Actual Care

- High Quality
- Care

- Quality Chasm

- Ineffective,
- Unsafe,
- Untimely,
- Not Patient
- Centered,
- Inefficient

- Actual Care
- for the
- Disadvantaged

- High Quality Care

- Ineffective,
- Unsafe,
- Untimely,
- Not Patient
- Centered,
- Inefficient,
- Inequitable

- +

- =  Quality Improvement
- for the Disadvantaged

**Linking Disparities & Quality**

## Goals of National Healthcare Reports

- National Level
- Provide assessment of quality and disparities
- Provide baselines to track progress
- Identify information gaps
- Emphasize interdependence of quality and disparities
- Promote awareness and change
- State / Local / Provider Level
- Provide tools for self-assessment
- Provide national benchmarks
- Promote awareness and change

## Measure Topics 

- Quality of Health Care
- Effectiveness
- Cancer, Diabetes, ESRD, Heart Disease, HIV/AIDS, Maternal and Child Health, Mental Disease, Respiratory Disease, Nursing Home and Home Health Care
- Safety
- Timeliness
- Patient centeredness

- Access to Health Care
- Getting into the system
- Insurance, Usual Source of Care, Perceptions of Need
- Perceptions of care
- Patient-provider communication, relationship
- Health care use

## Databases

**Surveys collected from samples of civilian, noninstitutionalized populations: **
- AHRQ, Medical Expenditure Panel Survey (MEPS), 1998-2000
- California Health Interview Survey (CHIS), 2001
- CDC-NCHS, National Health and Nutrition Examination Survey (NHANES), 1999-2000
- CDC-NCHS, National Health Interview Survey (NHIS), 1998 and 2000
- CDC-NCHS/National Immunization Program, National Immunization Survey (NIS), 2001
- CMS, Medicare Current Beneficiary Survey (MCBS), 1999
- The Commonwealth Fund, Health Care Quality Survey, 2001
- NCHS, National Health and Nutrition Examination Survey (NHANES), 1999-2000
- NCHS, National Health Interview Survey (NHIS), 1998 and 2000
- NCHS, National Immunization Survey (NIS), 2001
- SAMHSA, National Household Survey of Drug Abuse (NHSDA), 2000.
**Data collected from samples of health care facilities:**
- CDC-NCHS, National Ambulatory Medical Care Survey (NAMCS), 1999-2000
- CDC-NCHS, National Home and Hospice Care Survey (NHHCS), 2000
- CDC-NCHS, National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD), 1999-2000
- CDC-NCHS, National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED), 1999-2000
- CDC-NCHS, National Hospital Discharge Survey (NHDS), 1998-2000
- CDC-NCHS National Nursing Home Survey (NNHS), 1999
- CMS, End-Stage Renal Disease Clinical Performance Measurement Program, 2001
- CMS, Nursing Home Resident Profile Table, 2001
- NCHS, National Ambulatory Medical Care Survey (NAMCS), 1999-2000
- NCHS, National Home and Hospice Care Survey (NHHCS), 2000
- NCHS, National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD), 1999-2000
- NCHS, National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED), 1999-2000
- NCHS, National Hospital Discharge Survey (NHDS), 1998-2000
- NCHS’s National Nursing Home Survey (NNHS), 1999
- NIH, United States Renal Data System (USRDS), 2000
- SAMHSA, Client/Patient Survey Sample (CPSS), 1997.
- CMS, Quality Indicators program, 1998-1999.
**Data extracted from administrative data systems of health care organizations:**
- AHRQ, Healthcare Cost and Utilization Project State Inpatient Databases 16- State database (HCUP SID), 2000
- Medicare claim data from CMS
- HIV Research Network data (HIVRN), 2000.
**Data from surveillance and vital statistics systems:**
- CDC-National Center for HIV, STD, and TB Prevention, HIV/AIDS Surveillance System, 2000
- CDC-National Center for HIV, STD, and TB Prevention, TB Surveillance System, 1998-1999
- CDC-NCHS, National Vital Statistics System (NVSS), 2000
- NIH, Surveillance, Epidemiology, and End Results (SEER) program.

## QIs in the NHQR

- Source: NIS, SID
- Quality of Care 2003
- Admissions for diabetes
- Admissions for pediatric gastroenteritis
- Admissions for influenza
- Admissions for asthma
- Patient Safety Indicators
- Quality of Care 2004 & 2005
- Most IQIs: Cancer, cardiovascular disease, pneumonia

## QIs in the NHDR

- Source: NHDR Analytic File
- 22 States with “good” race data
- 65% of hospital discharges
- Imputation
- Weighting to national estimates
- Quality of Care: Same as NHQR
- Access to Care
- Avoidable admissions: hypertension, angina, COPD, pneumonia, perforated appendix

## New in the 2005 Reports

- Core Report Measures: 46 quality, 13 access
- Cross-walk to patient perceptions of care
- New data: Hospital Compare, NPCR, TEDS
- New measures: HIV, mental health care, substance abuse treatment
- New composite measures: AMI, heart failure, pneumonia, provider communication
- New analyses: Annual % change in quality, change in disparities

## Preliminary NHQR Findings

- Health Care Quality Continues To Improve at a Modest Pace Across Most Measures of Quality
- 10:1 ratio of measures improved to declined
- Overall improvement rate:  2.8%
- Health Care Quality Improvement Is Variable, With Notable Areas of High Performance
- Patient safety:  10.2%
- QIO Measures:  9.2%
- Effectiveness measures:  2.8%

## Preliminary NHQR Findings

- Many measures showing significant improvement  still far from Healthy People 2010 goals
- 70 years to reach goal for dialysis patients waiting for transplant
- Many measures slower to change & present significant challenges to quality improvement
- Smoking: Over a third of patients hospitalized for heart attack are not advised to quit smoking and rate has not changed over past 3 years

## Preliminary NHDR Findings

**Disparities are still pervasive**
- Blacks & American Indians worse off on 40% of quality measures, 50% of access measures
- Hispanics worse off on 50% of quality & 90% of access measures
- Poor worse off than high income on 85% of quality & 100% of access measures
**Many disparities are diminishing**
- Racial disparities are growing smaller rather than larger for 60% of quality core report measures & 100% of access measures

## Preliminary NHDR Findings

- Opportunities for improvement remain
- All groups worse off on some measures of care
- All groups worse off on some measures of care where the gap is growing larger
- Information about disparities is improving
- Each year, more, better, & new data – & fewer gaps
- New measures
- New MEPS variables: language, country of origin

## Contact information

- Dr. Ernie MoyLead Staff, NHDR301-427-1329emoy@ahrq.gov

- Dr. Dwight McNeillLead Staff, NHQR301-427-1734dmcneill@ahrq.gov

- _[www.qualitytools.ahrq.gov](http://www.qualitytools.ahrq.gov/)_
- Report requests: 	Giovanna Williams
- 					(301) 427-1543
-  					_[gwilliam@ahrq.gov](mailto:gwilliam@ahrq.gov)_