AHRQ Views: Blog posts from AHRQ leaders
A Fresh Look at the Data Shows Patient Safety Improving Overall, With Improvement Still Needed in Many Areas
As we recognize National Healthcare Quality Week, AHRQ is pleased to release a new Chartbook on Patient Safety, an important data resource that clearly underscores that quality improvement efforts start with protecting patients from avoidable harm.
The new Chartbook shows that the Nation’s ongoing focus on improving the safety of health care resulted in some encouraging overall gains between 2000 and 2016. However, there is much room for improvement, particularly for people of color and people in poor households.
For nearly two decades, AHRQ has supported health care providers’ efforts to keep patients safe when they receive medical care in hospitals, physician offices, nursing homes, ambulatory surgery centers, and other settings. The work has included reducing healthcare-associated infections, enhancing teamwork and communication, and supporting new initiatives to improve diagnosis in medicine. Another critical element of AHRQ’s work is to measure and monitor the status of these and other patient safety initiatives to ensure that the field continues to improve.
The data in the Chartbook are derived from the latest version of AHRQ’s National Healthcare Quality and Disparities Report, which was released in September 2018. The data include measures assessing patient safety performance in hospitals, home health settings, and ambulatory care. The Chartbook also assesses individual measures of patient safety by age, sex, race, ethnicity, income, education, insurance, health status, or the presence of various health conditions.
First the good news. Of the 36 measures used to evaluate patient safety, more than two-thirds (25) showed improvement. Here are the three measures that showed the greatest positive changes through 2015:
- Among medical and surgical discharges of length of 2 or more days in patients 18 years of age or older and among obstetric cases, there was a 64.7 percent decrease from 2008 to 2015 in central venous catheter-related bloodstream infections.
- Adverse events among adults who received hip joint replacements due to degenerative conditions decreased by 58.3 percent from 2009 to 2015.
- Adverse events in adults who received knee replacement fell by 49.5 percent from 2009 to 2015.
These gains and others show where progress has occurred. But equally important are Chartbook findings that identify ongoing safety concerns. Quantifying these challenges provides essential information to inform future quality improvement efforts.
The Chartbook shows, for example, that between 2000 and 2016, there was actually a decrease in the percentage of adults reporting that their home health care provider asked to see all the prescription and over-the-counter medicines they were taking when they first started getting home health care.
But more broadly, the Chartbook’s findings are a reminder that in many areas where quality improvement efforts are gaining ground, success has not occurred equally across patient populations. For instance, nearly 40 percent of measures with data stratified by income show that people living in poor households received worse care compared to those living in high-income households. In nearly 40 percent of measures with data stratified by race/ethnicity, Blacks received worse care compared with Whites. Nearly 30 percent of these measures show Asians receiving worse care compared with Whites. Awareness of specific health care disparities such as these helps ensure that improvement efforts target the most impactful opportunities for improvement.
Going forward, we hope that the Chartbook on Patient Safety serves as a go-to resource for the widening community of advocates who are devoted to making health care safer. Aside from providing the National Healthcare Quality and Disparities Report and the recently released State Snapshots, AHRQ is continuing to support the Nation’s efforts to improve quality and safety in health care in various other ways. Information on AHRQ’s patient safety initiatives are available at https://www.ahrq.gov/patient-safety/index.html.
Dr. Brady is Director of AHRQ’s Center for Quality Improvement and Patient Safety.
Ms. Chaves is Director of the National Healthcare Quality and Disparities Report Program in AHRQ’s Center for Quality Improvement and Patient Safety.