Health quality problems and racial disparities persist in U.S.

The federal Agency for Healthcare Research and Quality’s annual assessment of the state of health care in America noted that little progress was made to improve quality or reduce preventable errors and other adverse events such as health care-associated infections (HAIs).

Moreover, the agency’s annual report on disparities in care found that despite improvements in some areas, African-Americans, Hispanics, Asians and other minority groups continue to lag behind whites in the quality of their care. For example, even though there have been some incremental improvements, minorities are less likely than whiles to get preventative antibiotics at the right time before undergoing surgery. Such timely delivery of antibiotics is an important step toward preventing surgical site infections – a type of hospital-acquired infection that can often be prevented.


“Despite promising improvements in a few areas of health care, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access,” said Carolyn M. Clancy, director of the agency which is part of the Department of Health and Human Services. “Targeted AHRQ-funded research in Michigan has shown that infection rates of HAIs can be radically reduced. We are now working to make sure that happens in all hospitals.”

The agency’s 2009 National Healthcare Quality Report tracked five types of HAIs. The report found that while the rate of postoperative pneumonia improved 12 percent, bloodstream infections (sepsis) after surgery increased 8 percent. Urinary tract infections in patients with catheters rose 3.6 percent and the rate of other selected infections due to medical care increased 1.6 percent. And there was no change in the rate of central line-associated bloodstream infections.

The two reports also found that the large number of uninsured people in the country has slowed improvements in quality and reduction of racial disparities in care. “For many services, not having insurance is the single strongest predictor of poor quality care, exceeding the effects of race, ethnicity, income or education.”

The 2009 National Healthcare Disparities Report and the companion quality report include data on lifestyle modifications related to efforts to reduce obesity, a key health goal for many patients and providers.

The reports found:

  • One-third of obese adults have never received advice from their doctor about exercise.
  • Obese adults who are black, Hispanic, poor or have less than a high school education are less likely to receive diet advice from their doctor.
  • Most overweight children and one-third of obese adults report that they have not been told by their doctor that they are overweight.
  • Most American children have never received counseling from their health care provider about exercise, and almost half have never received counseling about healthy eating.