Agency for Healthcare Research and Quality Report Rates States in 14 Categories of Health Care Quality
The Agency for Healthcare Research and Quality on Monday released its second annual report comparing the 50 states and the District of Columbia in 14 categories of health care quality, the AP/Long Island Newsday reports (Freking, AP/Long Island Newsday, 4/4). The report, mandated by Congress, examined 2003 data collected from hospitals, health plans, nursing homes, home health agencies and other sources (Nelson, Long Island Newsday, 4/4).
About 100 measures of medical quality were reported in such areas as flu vaccines for state residents, prenatal care and the percentage of Medicare beneficiaries hospitalized with pneumonia who received antibiotics (Graham, Chicago Tribune, 4/5). Other data measured suicide rates, effectiveness of kidney dialysis and counseling Medicare beneficiaries with cardiac problems to quit smoking.
According to AHRQ Director Carolyn Clancy, the new report showed an across-the-board improvement of about 3% over last year. However, no one state performed well in every category, and demographics -- such as the ethnic composition of a population -- affected the rankings (Long Island Newsday, 4/4). AHRQ did not show which states performed the best or worst in each category but instead released the findings as 51 separate reports to show how each state compared with national averages.
"There is no best state or worst state," Clancy said, adding, "Improvement is needed in every state" (AP/Long Island Newsday, 4/4). Speaking at a Health Care Quality Summit sponsored by AHRQ, she noted that "patients in the leading states are getting care at a level of quality that is many times higher than the lowest performing states" (CQ HealthBeat , 4/4).
"I think fundamental change is occurring" in the quality of health care provided in the United States, Clancy said. However, she added that health care professionals should feel "impatience, anger and even outrage" at the "agonizin[g]" pace of quality improvement (CQ HealthBeat , 4/4). "[W]hat we have found both years is that there is a substantial gap between the health care we could provide and the quality of health care that we do provide," Clancy said (Long Island Newsday, 4/4).
Clancy noted that the largest improvement between 2003 and 2004 was in nursing home care, which is being monitored by CMS. "That shows the power and impact of that kind of monitoring," Clancy said, adding, "It's what's going to be needed in every state" (Altonn, Honolulu Star Bulletin, 4/4).
She called on policymakers to "summon up the energy that this difficult job demands," adding, "As health professionals and as citizens, we should be feeling 'shock and awe' when we see these chaotic differences in quality of care." Clancy said that AHRQ will make available $1 million to help states and other organizations learn from each other about how to improve care (CQ HealthBeat , 4/4).
Donald Berwick, president and CEO of the Institute for Healthcare Improvement, praised the report but added that the government must establish goals and deadlines for making improvements in the areas identified in the report. He noted that the United States has an "embarrassing gap" in the quality of care compared with other western democracies (AP/Long Island Newsday, 4/4). Berwick said, "It is a politically correct mantra to claim that the U.S. has the best health care system in the world. It does not."
He said the federal government needs to invest more money in researching how to improve care through information technology and other methods. Berwick also criticized the current trend of making patients more responsible for the cost of their health care, calling it an "unethical view of the relationship between suffering and health." Individual responsibility "is a tiny, tiny piece" of what should be done to improve care, he said.
Berwick also criticized proposals to tie physician reimbursements to care, saying the concept is a misunderstanding of what motivates doctors. Providers "need payment not for performance, but to support performance," he added (CQ HealthBeat , 4/4).
Arkansas Gov. Mike Huckabee (R), who also spoke at the conference, called on the United States to create a "culture of health" that "attacks the causes of disease." He added that he will make healthy living a major theme of his tenure as chair of the National Governors Association beginning this summer (Barton, Arkansas Democrat-Gazette, 4/5).
Larry Boress, vice president of the Midwest Business Group on Health, said the report "throws the gauntlet down to policymakers, health plans and providers to find out why problems exist and what can be done about them."
However, Stephen Persell, an instructor at Northwestern University's Feinberg School of Medicine, said the report is limited because state rankings are affected by differences in poverty rates, ethnicity makeup and insurance coverage (Chicago Tribune, 4/5).
Some patient advocates said the AHRQ report "is likely more useful for policymakers at the state level than for consumers," Newsday reports. Arthur Levin, a spokesperson for the Center for Medical Consumers, said the report provides good information but is not "user-friendl[y]" (Long Island Newsday, 4/4).
- "Ohio Gets Rankings on Health Measures" (Akron Beacon Journal, 4/5).
- "State's Health Report Card Mixed" (Schreiner, AP/Owensboro Messenger-Inquirer, 4/5).
- "Study: State a Leader in Cancer Screening" (Royse, AP/Tallahassee Democrat, 4/5).
- "Health Care Survey Puts State Near Norms" (Bjerga, Wichita Eagle, 4/5).