Two government reports show little progress in improving patient safety; reducing racial, ethnic health disparities

The U.S. has not made substantial improvement in narrowing health care disparities among racial and ethnic groups, nor has it improved quality of care, according to two Agency for Healthcare Research and Quality reports released on Wednesday by HHS, Politico reports (Allen, Politico, 5/6).

The health care disparities report found that some improvements have been made to narrow the gaps in quality among ethnic groups, but some of the most significant disparities remain. For example, black U.S. residents continue to be almost 10 times more likely than whites to get HIV/AIDS -- a rate that has changed little since 2005. Blacks also are twice as likely to have a leg amputated because of diabetes, while pregnant black women are twice as likely not to receive prenatal care during their first trimester, according to the study.

In the quality-of-care report, researchers found measurable improvement in fewer than half of the 38 patient safety measures studied, such as accidental lacerations and catheter-associated infections. The study found that patient safety measures on average declined by nearly 1% annually in each of the last six years. According to AHRQ, one of every seven hospitalized Medicare beneficiaries has experienced at least one adverse event, a finding the agency called "disturbing." In addition, the study found significant variation in quality between states and among procedures. Carolyn Clancy, director of AHRQ, said that the study found a "collective lack of dramatic improvement" in quality of care, noting that the percentage of diabetics in 2005 who received each of three recommended annual treatments for the disease declined by five percentage points since 2003 to 40%.

According to the report, "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 states, "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" (Sack, New York Times, 5/7).

Sebelius Comments

Speaking to the American Federation of State, County and Municipal Employees Nurses Congress on Wednesday, HHS Secretary Kathleen Sebelius said the report found that "40% of recommended care is not received by patients." She added, "In addition, prevention measures are lacking. Only half of obese adults and children are given advice to exercise more and eat a healthy diet. Perhaps most troubling was the decline in patient safety measures indentified in the quality report, which have worsened each year for the past six years."

According to Sebelius, the economic stimulus package "includes $50 million to help prevent health care-associated infections, and I am pleased to announce that [HHS] is making these funds available today. Forty-million dollars will help states expand their infection prevention teams and educate and collaborate with hospitals to keep people safe. Ten-million dollars will support increased inspections of ambulatory surgical centers -- a frequent site of infections." She also said, "If we are to succeed and make health reform a reality, we need nurses at the forefront of the effort" (Politico, 5/6).

The reports are available online.