Since 2003, the Agency for Healthcare Research and Quality (AHRQ) has reported on progress and opportunities for reducing disparities and improving the quality of healthcare delivered across a variety of healthcare settings. AHRQ released two reports – the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR) – until they were combined into the NHQDR in 2014 for a more integrated assessment of the performance of the U.S. healthcare system. Mandated by the U.S. Congress, the report focuses on “national trends in the quality of health care provided to the American people” (42 U.S.C. 299b-2(b)(2)) and “prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations” (42 U.S.C. 299a1(a)(6)).
The 2021 report covers approximately 230 process, outcome, and access measures to provide an overview of the healthcare system summarized around the concepts of access to care, quality of care and disparities in care, and six priority areas (patient-centered care, patient safety, care coordination, affordable care, effective treatment, and healthy living). Specific to disparities, the report highlights differences in access to care and quality of health for priority populations defined by age, sex, race, ethnicity, income, education, health insurance, and geographic location. All measures reported in the 2021 NHQDR were collected in 2019 or prior, providing a snapshot of the U.S. healthcare system as it entered the COVID-19 pandemic.
Some key findings and trends from the 2021 report include:
- The leading causes of death in the U.S. are heart disease, cancer, and unintentional injuries.
- Death from heart disease and cancer have declined while death rates for unintentional injury have been increasing. Rates of suicide have also been increasing.
- Compared to their White counterparts, the number of measures that were worse exceeded the number of measures that improved for all racial and ethnic minority groups except Asian groups.
- The opioid and mental health crisis worsened in the years leading up to COVID-19, potentially driven by limited access to substance abuse and mental health treatment.
- While Black, Hispanic, and American Indian and Alaska Native communities all experienced substantial improvements in healthcare quality, significant disparities in all domains of healthcare quality persist.
- The report highlights that even prior to the COVID-19 pandemic, physician shortages existed in many states across the nation, and people of color remain under-represented in several healthcare professions. A lack of racial, ethnic, and gender concordance between providers and patients can result in suboptimal healthcare.
The NHQDR offers opportunities to the IPRO community of hospitals, nursing homes, providers and other stakeholders to improve healthcare quality and reduce disparities. Persistent disparities in care by race, ethnicity, and other socioeconomic factors underscore the need to continue our collaborative efforts to provide equitable healthcare in the U.S.
Full report files: National Healthcare Quality and Disparities Report (NHQDR)