This 2014 report from the Agency for Healthcare Research and Quality consolidates the annual National Healthcare Quality Report and National Healthcare Disparities Report. These reports to Congress are mandated by the Healthcare Research and Quality Act of 1999 (P.L. 106-129).  The consolidated report highlights the importance of examining quality and disparities together to gain a complete picture of health care. The report provides a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The report is based on more than 250 measures of quality and disparities covering a broad array of health care services and settings.  This shorter, consolidated report only provides summary and illustrative measures rather than providing detailed measures as in prior years’ reports.  Additional data are available in chartbooks.

The report and supporting chartbooks are further integrated with the National Quality Strategy (NQS). The NQS has three overarching aims that support HHS’s delivery system reform initiatives to achieve better care, smarter spending, and healthier people through incentives, information, and the way care is delivered. These aims are used to guide and assess local, state, and national efforts to improve health and the quality of health care.

The report highlights that access improved:

  • After years without improvement, the rate of uninsurance among adults ages 18-64 decreased substantially during the first half of 2014.
  • Through 2012, improvement was observed across a broad spectrum of access measures among children.

Quality improved for most NQS priorities:

  • Patient Safety improved, led by a 17% reduction in rates of hospital-acquired conditions between 2010 and 2013, with 1.3 million fewer harms to patients, an estimated 50,000 lives saved, and $12 billion in cost savings.
  • Person-Centered Care improved, with large gains in patient-provider communication.
  • Many Effective Treatment measures, including several measures of pneumonia care in hospitals publicly reported by the Centers for Medicare & Medicaid Services (CMS), achieved such high levels of performance that continued reporting is unnecessary.
  • Healthy Living improved, led by doubling of selected adolescent immunization rates from 2008 to 2012.

Few disparities were eliminated:

  • People in poor households generally experienced less access and poorer quality.
  • Parallel gains in access and quality across groups led to persistence of most disparities.
  • At the same time, several racial and ethnic disparities in rates of childhood immunization and rates of adverse events associated with procedures were eliminated, showing that elimination is possible.

Many challenges in improving quality and reducing disparities remain:

  • Performance on many measures of quality remains far from optimal. For example, only half of people with high blood pressure have it controlled. On average, across a broad range of measures, recommended care is delivered only 70% of the time.
  • As noted above, disparities in quality and outcomes by income and race and ethnicity are large and persistent, and were not, through 2012, improving substantially.
  • Some disparities related to hospice care and chronic disease management grew larger.
  • Data and measures need to be improved to provide more complete assessments of two NQS priorities, Care Coordination and Care Affordability, and of disparities among smaller groups, such as Native Hawaiians, people of multiple races, and people who are lesbian, gay, bisexual, or transgender.

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