19 April 2010
Improvements in patient safety continue to lag, according to the 2009 National Healthcare Quality Report and National Healthcare Disparities Report issued recently by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.
Very little progress has been made on eliminating health care-associated infections (HAIs), according to a new section in the 2009 quality report. For example, of the five types of HAIs in adult patients who are tracked in the reports:
• Rates of postoperative sepsis, or bloodstream infections, increased by 8 percent.
• Postoperative catheter-associated urinary tract infections increased by 3.6 percent.
• Rates of selected infections due to medical care increased by 1.6 percent.
• There was no change in the number of bloodstream infections associated with central venous catheter placements, which are tubes placed in a large vein in the patient’s neck, chest, or groin to give medication or fluids or to collect blood samples.
• However, rates of postoperative pneumonia improved by 12 percent.
In addition, although rates are improving incrementally, blacks, Hispanics, Asians, and American Indians are less likely than whites to receive preventive antibiotics before surgery in a timely manner.
“Despite promising improvements in a few areas of health care, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access,” said AHRQ Director Carolyn M. Clancy, M.D. “Targeted AHRQ-funded research in Michigan has shown that infection rates of HAIs can be radically reduced. We are now working to make sure that happens in all hospitals.”
Over 100 participating hospital intensive care units in Michigan have been able to keep the rates of central line-associated bloodstream infections to near zero, 3 years after adopting standardized procedures. The project, conducted by the Michigan Health and Hospital Association Keystone Center, involved the use of a comprehensive unit-based safety program to reduce these potentially lethal infections. Last year, AHRQ announced new funding that has expanded the project to all 50 states, Puerto Rico, and the District of Columbia.
AHRQ’s annual quality and disparities reports, which are mandated by Congress, were first published in 2003. The reports show trends by measuring health care quality for the nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in four areas of quality: effectiveness, patient safety, timeliness, and patient-centeredness.
The 2009 reports include a new section on lifestyle modifications, because preventing or reducing obesity is a crucial goal for many Americans and an important task for health care providers.
The reports found:
• One-third of obese adults have never received advice from their doctor about exercise.
• Obese adults who are black, Hispanic, poor or have less than a high school education are less likely to receive diet advice from their doctor.
• Most overweight children and one-third of obese adults report that they have not been told by their doctor that they are overweight.
• Most American children have never received counseling from their health care provider about exercise, and almost half have never received counseling about healthy eating.
The reports indicate that the lack of health insurance slows improvement in health care quality and reduction of disparities. For many services, not having insurance is the single strongest predictor of poor quality care, exceeding the effects of race, ethnicity, income or education.
Americans with no insurance are much less likely then those with private insurance to obtain recommended care, especially preventive services and management for diabetes. While differences between blacks and whites in the rates of lack of insurance have narrowed in the past decade, disparities related to ethnicity, income and education remain large.
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