The Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services (HHS), has produced its seventh yearly National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR). The reports examine the state of effectiveness in health care, patient safety, timeliness, patient-orientation and efficiency of care.

The National Healthcare Quality Report tracks the health care system through quality measures, basically concerning: the status of health care quality in the United States, where health care quality improvement is most needed, and how the quality of health care in the U.S. has changed over time. Part of the reason the AHRQ provides the report is that the agency has found that American health care continues to fall short of optimal conditions, with a substantial gap between the best possible care and that which is "routinely delivered." "Across the core report measures tracked in the NHQR, the median level of receipt of needed services was 58%. We can and should do better," the authors state.

The NHQR points out several ongoing problems in the health care system, such as the fact that uninsured people are less likely to obtain disease prevention measures, or chronic disease management. However, both uninsured and insured individuals are about equally likely to be able to consult with health providers about medications, treatments from other doctors, and to receive care related to HIV infection.

The Report finds one of the major areas for improvement is health care-associated infections (HAIs). The NHRQ notes that many HAIs have increased in the past year and HAIs are considered to be one of the most urgent issues in patient safety. For example, the rate of postoperative sepsis is worsening rapidly. While timely receipt of prophylactic antibiotics for surgery is improving, other HAI outcome measures are worsening or show no change. The report states that the rates may, however, in part be reflecting improved detection of HAIs.

On a more positive note, more awareness regarding patient safety and HAIs exists, as well as improved event reporting systems and national standards for data collection. The report offers further recommendations for improvement: evolving new quality measures for emerging issues, understanding the patient perspective, removing barriers to quality care, and provider training (including on health information technology).

The National Health Care Disparities Report reviewed health care quality and access among various demographics: racial, ethnic, age, income group and other groups, and identified the gaps in populations -- who receives better or worse care. The information in the NHDR showed that disparities in populations are still common, with lack of insurance being a main cause. In addition, many such disparities are not decreasing, and some should receive greater attention: for cancer, heart failure and pneumonia. The disparities related to race, ethnicity, and socioeconomic status are reflected in areas of health care quality, access to levels and types of care, settings of care (hospital, nursing home) and in sub-populations: women, children, elderly, rural residents, persons with disabilities and/or special needs.

In the measures used for the report, a significant portion of racial/ethnic minorities and poorer people receive lower quality care and have worse access to care. Access includes insurance coverage and being able to use general health service, such as being able to obtain appointments with a provider. Preventative care also presented a major area of disparity. Other significant disparities included the rate of new AIDS cases among African-American, American Indian/Alaska Native and Hispanic populations, and disparities for Asians and poor populations related to timeliness of care.

Secretary Sebelius stated after the release of the reports on Tuesday: "Today's reports demonstrate why passing health reform was so critical." "In 2009, health care associated infections increased and minorities were less likely to have insurance and less likely to get the treatments they needed. In a reformed system, more Americans will get the care they need, regardless of their race or ethnicity and the quality of care will improve. The numbers we saw today are troubling, but ultimately, reform will help turn these numbers around."

The AHRQ reports can be accessed at: http://www.ahrq.gov/qual/qrdr09.htm

Secretary Sebelius' statement: http://www.hhs.gov/news/press/2010pres/04/20100413a.html

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