Government reports show no progress in improving quality of health care among ethnic groups
07 05 09 - 15:25
Government Reports Criticize Health Care System
By KEVIN SACK - The New York Times
Two annual government reports released Wednesday show that progress in improving the quality of health care and narrowing health disparities among ethnic groups remains agonizingly slow, and that patient safety may actually be declining.
One of the reports, compiled by the Agency for Healthcare Research and Quality, found measurable improvement in fewer than half of the 38 patient safety measures examined, like accidental lacerations and catheter-associated infections. The agency concluded that one of every seven hospitalized adults on Medicare had experienced at least one adverse event, calling the finding “disturbing.”
“Despite promising improvement in select areas, the health care system is not achieving the more substantial strides needed to close the gap or ‘quality chasm’ that persists,” the report concluded. “Despite efforts to transform the U.S. health care system to focus on effective preventive and chronic illness care, it continues to perform better when delivering diagnostic, therapeutic, or rehabilitative care in response to acute medical problems.”
A separate report on health care disparities noted some improvements in closing the gaps between ethnic groups but found little progress in addressing the most glaring differences. For instance, black Americans continue to be nearly 10 times more likely than whites to contract AIDS, little changed since 2005. They are twice as likely to have a leg amputated because of diabetes and pregnant black women are twice as likely not to receive prenatal care in the first trimester.
Dr. Carolyn M. Clancy, the agency’s director, said the reports’ most notable finding was “the collective lack of dramatic improvement.” She noted, for instance, that only 40 percent of diabetics were receiving each of three recommended annual treatments: a hemoglobin test, an eye exam and a foot exam. That figure, for 2005, was down by 5 percentage points from 2003.
Like previous research, the studies found significant variations in quality between states and among procedures. The rate of influenza vaccinations for diabetic adults was as high as 66 percent in one state and as low as 24 percent in another. While 96 percent of hospitalized heart attack patients received recommended care, like the administration of aspirin and beta blockers, only 60 percent of colon cancer patients were properly treated through the removal of lymph nodes for biopsy.
Across 45 core measurements, the median level of receipt of needed care was only 59 percent. “We can and should do better,” the report on quality said.
While progress was being made in almost all of the core measures, the median annual rate of improvement was only 1.8 percent. The rate of improvement in the treatment of acute conditions, like heart attacks, was twice that for prevention or for the management of chronic conditions, like cancer screenings. The rate of improvement was more marked in hospitals than in long-term care or ambulatory care facilities.
The agency found an average decline of nearly 1 percent in its patient safety measurements over each of the last six years. Contributing to the drop were increases in the rate of accidental punctures and lacerations during procedures and of infections and other complications stemming from the placement of central venous catheters.
The secretary of health and human services, Kathleen Sebelius, highlighted the reports on Wednesday in announcing the availability of $50 million in federal stimulus grants to helps states combat infections associated with health care. She also challenged hospitals to reduce blood stream infections from central catheters by 75 percent over the next three years.