The 2017 National Healthcare Quality and Disparities Report (QDR), published by the Agency for Healthcare Research and Quality (AHRQ), assesses the performance of the US healthcare system and identifies areas of strength and weakness, as well as disparities, for access to healthcare and quality of healthcare. The report assesses six quality areas:

• Person-centered care: This area includes measures of patient engagement, shared decision-making, and care coordination.
• Patient safety: This area includes measures of preventable adverse events and healthcare-associated infections.
• Healthy living: This area includes measures of preventive care, such as immunizations and cancer screenings.
• Effective treatment: This area includes measures of appropriate use of medications and procedures, as well as clinical outcomes.
• Care coordination: This area includes measures of communication and coordination of care between different providers and settings.
• Care affordability: This area includes measures of out-of-pocket spending and financial burden.

Key Findings

The QDR found that there has been progress in some quality areas, but there is still room for improvement. Some of the key findings include:

• Person-centered care: Almost 70% of person-centered care measures were improving overall. However, there were significant disparities by race and ethnicity, with black and Hispanic patients less likely to report high-quality person-centered care.
• Patient safety: More than two-thirds of patient safety measures were improving overall. However, preventable adverse events still occurred too often, and there were significant disparities by race and ethnicity, with black and Hispanic patients more likely to experience preventable adverse events.
• Healthy living: More than half of healthy living measures were improving overall. However, there were significant disparities by race and ethnicity, with black and Hispanic patients less likely to receive preventive care.
• Effective treatment: More than half of effective treatment measures were improving overall. However, there were significant disparities by race and ethnicity, with black and Hispanic patients less likely to receive appropriate care.
• Care coordination: Half of care coordination measures were improving overall. However, there were significant disparities by race and ethnicity, with black and Hispanic patients less likely to experience coordinated care.
• Care affordability: Eighty percent of care affordability measures did not change overall. However, out-of-pocket spending continued to be a burden for many Americans, and there were significant disparities by income, with low-income Americans more likely to have high out-of-pocket spending.

Real-Life Examples

Here are some real-life examples of the six quality area findings from the 2017 QDR:

• Person-centered care: A patient with diabetes may see multiple specialists for different aspects of their care. Person-centered care would mean that all of the patient’s providers communicate and coordinate with each other to develop a comprehensive care plan that is tailored to the patient’s individual needs.
• Patient safety: A patient may be hospitalized for a routine surgery, but they develop a healthcare-associated infection, such as a hospital-acquired pneumonia. Patient safety measures would include things like handwashing protocols and antibiotic stewardship programs to help prevent these infections from happening.
• Healthy living: A patient may be at high risk for developing colon cancer, but they have never been screened for the disease. Healthy living measures would include things like cancer screening guidelines and reminders for patients to get screened.
• Effective treatment: A patient with a heart attack may not receive the medications that they need to prevent another heart attack. Effective treatment measures would include things like guidelines for the use of medications in patients with heart disease and quality improvement programs to ensure that patients are receiving the recommended care.
• Care coordination: A patient with multiple chronic conditions may see different doctors for each condition, but their doctors do not communicate or coordinate with each other. Care coordination measures would include things like electronic health records that allow providers to share information about the patient’s care and care management programs that help to coordinate the patient’s care across multiple providers and settings.
• Care affordability: A patient with a low income may have difficulty paying for their medications or healthcare services. Care affordability measures would include things like subsidies and financial assistance programs to help low-income Americans afford healthcare.

Interpretation

The findings of the 2017 QDR suggest that the US healthcare system is making progress in some quality areas, but there is still room for improvement, particularly in terms of disparities in care.