# Presentation: 228512

## 2007 National Healthcare Quality Report (NHQR)

**Health care quality continues to improve, but the rate of improvement has slowed**

- Released March 3, 2008

## Annual Median Rate of Change

- The annual median rate of change from 1994 to 2005 was 2.3%
- From 2000 to 2005, the annual median rate of change was 1.5%

- n=number of measures

## Improvement in Core Measures

- Most measures show some improvement
- Of the 41 core measures reported with data that span 1994-2005:
- 27 improved
- 6 declined
- 6 showed no change

## Variation in Health Care Quality

- Variation in quality of health care across the Nation is decreasing, but not for all measures
- More measures have seen progress in terms of decreases in variation between the best performing State and the worst performing State between 2000 and 2005:
- Variability decreased for 28 measures
- Variability increased for 13 measures
- There was no change for 18 measures

## Example of Decreased Variation

- Heart attack patients given smoking cessation counseling while hospitalized

**Source:** CMS, Medicare Quality Improvement Organization Program

## Patient Safety

- The safety of health care has improved since 2000, but more needs to be done

- n=number of measures

## Rates of Improvement

- Safety improved slightly between 2000 and 2005, at an annual rate of 1%
- Other areas improved at significantly greater rates, such as care for heart disease (5.6%)

## Rates of Improvement

- Areas where significant attention has been concentrated, such as appropriate timing of antibiotics for surgery and reducing medication errors, have shown progress:
- Over 30% more patients received appropriate timing for antibiotics before and after surgery in 2005 than in 2004
- From 2004 to 2005, adverse drug events from warfarin and low-molecular-weight heparin declined 21% and 28%, respectively
- Deaths following complications of care declined 2.4% from 1994 to 2004

## Patient Safety Data

- In many areas, data needed to track patient safety effectively are not available
- In most cases, clinicians lack basic monitoring data on medical errors and adverse events. For example:
- Only 25 of 41 safety measures in the full NHQR measure set have data available for tracking recent trends
- No national data systems currently report data on safety at a State or local level
- Because adverse events and medical errors are rare events from a statistical perspective, it is difficult to compare across time or patient groups

## Origin of NHQR

- Health and Human Services Secretary required to submit annual report to Congress:
- National trends in health care quality (National Healthcare Quality Report, or NHQR)
- Prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations (National Healthcare Disparities Report, or NHDR)

**Mandated by Congress in Healthcare Research and Quality Act (PL. 106-129)**

## NHQR and NHDR Goals

- Provide a snapshot of health care delivery
- 41 core measures of quality and access
- 211 total measures
- Indicate the biggest gaps in care
- Show national and State trends
- Tell us how we can reach our goals
- Help align measures across public and private quality initiatives

## NHQR and NHDR Framework

| Consumer Perspectives on Health Care Needs | Components of Health Care Quality |  |  |  |
| --- | --- | --- | --- | --- |
|   | Safety | Effectiveness | Patient Centeredness | Timeliness |
| Staying healthy |   |   |   |   |
| Getting better |   |   |   |   |
| Living with illness or disability |   |   |   |   |
| Coping with end-of-life matters |   |   |   |   |

**Source:** Institute of Medicine Committee. “Envisioning the National Health Care Quality Report,” 2001

## Relationship Between NHQR and NHDR

| NHQR | NHDR |
| --- | --- |
| Snapshot of quality of health care in America | Snapshot of disparities in health care in America |
| Quality | Quality + access |
| Safety, effectiveness, timeliness, patient centeredness
 | Safety, effectiveness, timeliness, patient centeredness + equity |
| Variation across States | Variation across populations
 |

## NHQR/NHDR Content and Organization

- Effectiveness
- Cancer
- Diabetes
- End Stage Renal Disease (ESRD)
- Heart Disease
- HIV and AIDS
- Maternal and Child Health
- Mental Health and Substance Abuse
- Nursing Home, Home Health,
- and Hospice Care
- Patient Safety
- Timeliness
- Patient Centeredness
- Access to Health Care
- Priority Populations
- *Also includes a chapter on Efficiency

- NHQR*

- NHDR

## New in the 2007 NHQR

- Chapter 2, Cancer: Cancer treatment measures (two for breast cancer, one for colon cancer) from National Cancer Data Base, American Cancer Society and American College of Surgeons
- Chapter 2, HIV and AIDS: HIV testing measures, CDC National Survey on Family Growth
- Chapter 2, Nursing Home and Home Health: Pain management for nursing home residents, CDC National Nursing Home Survey
- Chapter 6, Efficiency

## For more information...

- NHQR and NHDR Web page _[http://www.ahrq.gov/qual/qrdr07.htm](http://www.ahrq.gov/qual/qrdr07.htm)_
- NHQRnet for data tables and queries
- _[http://nhqrnet.ahrq.gov/nhqr/jsp/nhqr.jsp](http://nhqrnet.ahrq.gov/nhqr/jsp/nhqr.jsp)_
- Request a copy (AHRQ publication no. 08-0040) from AHRQ Publications Clearinghouse
- 1-800-358-9295 or _[AHRQPubs@ahrq.hhs.gov](mailto:AHRQPubs@ahrq.hhs.gov)_