Whitney Palmer

AHRQ Releases Reports on Healthcare Quality and Disparities

Published in the February 2004 AAMC Reporter

Healthcare quality in the United States is rising, but adequate services still are not available to everyone, according to two reports released in December by the Department of Health and Human Services (HHS) and the Agency for Healthcare Research and Quality (AHRQ). Wide disparities still exist for some racial, ethnic, and socioeconomic groups.

The two reports, the first in an annual series of studies mandated by Congress, take a comprehensive look at the differences in health quality in reference to a patient’s race, income, education, and residence. Both agencies expressed hope that the National Healthcare Quality report and the National Healthcare Disparities Report could be used to improve areas of unsatisfactory healthcare performance.

“These reports can be considered our road maps to success,” said Carolyn Clancy, M.D., director of AHRQ, in a Washington, D.C., press conference. “They will help us achieve an important priority for this nation: ensuring that all Americans have the safest, highest-quality health services possible available to them when needed.”

However, barely a month after the reports’ official release, the Washington Post reported that HHS delayed the publication in order to put a more positive spin on the results and shift the focus away from the lingering short-comings of the public healthcare system. The article quoted government officials as saying, “The tone of the report had been changed, [to reflect] HHS Secretary Tommy G. Thompson’s strategy of triggering improvement by focusing on the positive.”

According to Nicole Lurie, M.D., MSPH, senior natural scientist and Paul O’Neill Alcoa Professor of Health Policy at Rand, the revised report does not reflect the realities of the healthcare system. Dr. Lurie played a role in the push for the creation of these reports under the Clinton administration.

“You need to look at the data because this is a case where the executive summary is deceiving and has a completely different message,” Lurie said. “It doesn’t reflect the contrasts of the report at all — the data in the report continues to highlight what we now know is a widespread systemic problem.”

In addition to the reports, AHRQ launched a Web site called Quality Tools, http://www.qualitytools.ahrq.gov, to help the healthcare system improve. The site features tools for “assessing, measuring, promoting and improving healthcare quality.” For example, it includes a list of 20 tips to avoid medical errors and guidance for selecting and using a health plan.

The disparities report listed several key findings tied directly to a patient’s genetic or economic background. Although the country as a whole enjoys a high level of care, poorer citizens and those from some minority groups are more likely to be uninsured. In addition, the study indicates African-American populations suffer a high death rate from cancer and Native Americans are less likely to have cholesterol checks.

As mentioned in the Post article and in line with the department’s attempt to focus on system improvements rather than failures, the report highlights that some groups defined as ” priority populations” fare as well as or better than the general population. For example, black and Hispanic patients more commonly report their healthcare provider inquired about medications prescribed by other physicians.

Past president of the National Medical Association Lucille Norville Perez, M.D., praised the AHRQ reports but urged further analysis of disparities affecting racial and ethnic populations. She believes more research is necessary because “racial minorities don’t receive the same care as their white counterparts,” and she anticipated future reports that would provide more data in this area.

Other findings in the disparities report include the challenges presented in caring for chronic disease, missed opportunities in healthcare for minority and lower socioeconomic groups, and a realization that the healthcare industry still has room for improvement.

The quality report, while reiterating many of its companion report’s findings, also illuminated the current state of healthcare. Improvements have been made in 20 out of 57 healthcare areas, including earlier cancer detection and routine blood sugar and cholesterol level checks for diabetic patients. Advancements still need to be made in elder care and hypertension treatment, as well as the remaining 37 health areas.

This report also examined missed opportunities regarding preventive care, such as counseling patients to quit smoking. According to the report, even though smoking remains the No. 1 preventable cause of mortality nationwide, only 40 percent of patients receive smoking prevention counseling during a hospital visit to 60 percent receive it during office visits.

Disseminating quality care information and developing methods to improve healthcare quality and reduce disparities is the next step for AHRQ, Clancy said. Already, grant programs are looking to apply this evidence-based information to ways of improving the quality of care. She believes these new programs could foster a noticeably higher level of quality in upcoming years.

Joxel Garcia, M.D., deputy director of the Pan American Health Organization, hopes this increasing focus on proper care does not stop at America’s borders. Garcia believes the improvements made in U.S. healthcare must be applied to healthcare within the entire Western Hemisphere and beyond.

“This is a great opportunity — a giant step — to benchmark healthcare in all regions of the world, starting in the Western Hemisphere,” he said. “We shouldn’t expect a miracle, but it’s at least a first step.”

March 27, 2010 Posted by wjpalmer | Healthcare, Politics | Agency for Healthcare Research Quality, Department of Health and Human Services, ethnic disparities, healthcare disparities, improving healthcare system performance, racial disparities, socioeconomic disparities | Leave a comment