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One Step Forward on Quality Improvement, One Step Back on Access

Agency for Healthcare and Quality (AHRQ)
by Carolyn M. Clancy, MD

You may already know that heart disease is the top cause of death for both men and women and is responsible for one in four deaths in the United States. It also costs more than $400 billion each year in health care services, drugs, and other expenses.

But here's good news: Patients with heart disease are getting better quality of care. Better care has led to fewer hospital admissions and deaths.

A new set of reports from the Agency for Healthcare Research and Quality (AHRQ) show that fewer patients go to the hospital with congestive heart failure and that fewer patients die from heart attacks in the hospital. Patients who have heart attacks are getting faster access to angioplasty, a procedure to open blocked arteries.

These findings come from AHRQ's 2011 National Healthcare Quality and Disparities Reports, released last month. Since 2003, these reports have helped track our progress and identify where we need more work to build the best possible health care system for all Americans.

Not only do the reports show that quality of care for heart disease is getting better, they also found that some outcomes for blacks with this condition are better than for whites.

For example, blacks had a lower rate of hospital deaths from heart attacks than whites. And blacks with congestive heart failure were more likely than whites to receive an angiotensin-converting enzyme (ACE) inhibitor, a medication to help heart function, when they left the hospital. For other conditions, such as cancer and diabetes, blacks typically had worse outcomes than whites.

Access to health care did not improve for most racial and ethnic groups. Half of the measures that tracked disparities in health care showed no improvement, and 40 percent of those measures got worse.

And health care quality, while getting better, is improving at a slow rate (2.5 percent) each year. We've learned a lot in the past decade about how to improve health care quality. But much work remains to close the gap between what we know and what we practice.

Of course, each of us has a big role to play in staying healthy and preventing disease. Lifestyle factors, which include exercise, not smoking, a healthy diet, and regular exercise, account for more than 40 percent of the differences in an individual's health.

Lifestyle factors also affect obesity, which can cause or worsen many diseases. Today, about one-third of adults are obese and 17 percent of children and teens are obese.

Health care providers are learning they need to help educate parents and children about obesity and how to prevent it. Nearly half of health care providers said they offered advice to parents about why their child should follow a healthy diet, the reports found. About the same percentage of adults said they got advice from a health care provider about their own eating habits.

Slightly more than half (57 percent) of obese adults got advice from a health provider about exercise. About one-third (34 percent) of parents got this information for their child or teen.

You can play an important role in staying healthy by educating yourself and your family members about lifestyle choices. Another thing you can do is ask your health care provider questions so you can address your concerns together.

We have a long way to go before our health care system works as well as we want it to work for all Americans. As we reach toward that goal, let's put into action the things we know can make a difference right now.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

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