Gauging the quality of healthcare systems is often difficult and restricted by the availability of data. One method for measuring quality is to look at mortality rates. Mortality rates can be influenced by a myriad of factors, one of which is the quality of the healthcare system for diseases where mortality is amenable to health care. The mortality rate (number of deaths per 100,000 people) in the U.S. has fallen about 30 percent between 1980 and 2010.
From 2000 to 2013, the infant mortality rate in the U.S. improved by about 13 percent.
Researchers have looked at mortality that results from medical conditions for which there are recognized healthcare interventions that would be expected to prevent death. While the healthcare system might not be expected to prevent death in all of these instances, differences in mortality for these conditions provides information about how effectively healthcare is being delivered. From 2002-2010, the mortality rate for deaths amenable to healthcare in the US has steadily declined.
Potential Years of Life Lost (PYLL) is a measure of premature death. The U.S. has made progress in reducing PYLL’s over the last thirty years.
Disability adjusted life years (DALYs) are a measure of disease burden and the rate per 100,000 shows the total number of years lost to disability and premature death. The disease burden has declined about 15 percent from 1990 – 2013.
The percentage of people reporting poor general health has increased across males, females, whites, and Hispanics. Women and Non-Hispanic blacks are more likely to report being in poor health than other groups. While all groups other than Non-Hispanic blacks have increased the reporting of poor general health by about 32 percent, Non-Hispanic blacks have continuously had the largest percentage of people reporting poorer health than any other group.
The percentage of people reporting poor physical and mental health has worsened over time.
Healthy days is a measure of Health Related Quality of Life that represents the average number of days in the past 30 that respondents’ mental and physical health is reported as good. Since 1996, the average number of general, mental, and physical “healthy days” has declined.
Screening and prevention can improve health outcomes when a disease is caught in the early stages. Screening and prevention among adults 50 and older has remained fairly static from 2006 to 2012.
The Children’s Health Insurance Program (CHIP) was established in 1997 and made health insurance available to children in near-poor families who are ineligible for Medicaid. One of the CHIP mandates is to cover the cost and administration of childhood vaccines. This program has helped ensure children continue to receive the recommended vaccinations, but prior to the passage of CHIP there was a significant increase in the percentage of children receiving vaccinations. Children receiving recommended doses of vaccines for Diphtheria, Tetanus, Pertussis, Measles, and Hepatitis B has increased by about 46 percent from 1993-2013.
The birth rate for teenagers in the U.S. has declined but there are large differences among states. Teen birth rates in the Northeast have generally been the lowest, while birth rates in the South and Southeast have generally been the highest across the U.S.
The percentage of people with an overweight, obese, or extremely obese body mass index (BMI) for people in the United States has increased by 22 percent from the 1988-1994 time period to 2011-2012.
While not all hospital admissions for ambulatory care sensitive conditions are preventable, access to appropriate primary health care can prevent the onset of these types of illnesses and conditions. Proper management of diseases like asthma, chronic obstructive pulmonary disease, diabetes, and hypertension can help reduce hospital admissions. Medicare hospital admissions for ambulatory care-sensitive conditions have decreased from 2007 to 2013.
The proportion of patients receiving recommended care increased from 66 percent in 2005 to 70 percent in 2010, though most of that improvement occurred between 2005 and 2007 (not shown in chart).
Patients’ perspectives on hospital care provide another method for measuring the quality of the health care system. Staff response to hospitalized patients has improved nearly 10 percent from 2007 – 2013.
There are well established evidence-based courses of care for various diseases, such as breast cancer. In 2011, 94.3% of women received axillary node dissection or sentinel lymph node biopsy at the time of lumpectomy or mastectomy in order to ensure proper diagnosis and identify the possible spread of cancer to the lymph nodes.
Receiving evidence-based treatment upon presentation of a heart attack can minimize mortality. Between 2005 and 2012, hospital patients with a heart attack increasingly received percutaneous coronary intervention within 90 minutes of arrival and fibrinolytic medication within 30 minutes of arrival.
Since 2005, an increasing percentage of patients who experienced heart failure and left ventricular systolic dysfunction have been discharged with a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker.
When patients are given instructions for recovery at home after hospitalization it can improve health outcomes. From 2007 to 2013, about 9 percent more patients are receiving instructions for recovery at home.
Hospital acquired conditions (HACs) are infections or conditions that people get while they are in the hospital that could have reasonably been prevented through the application of evidence-based guidelines. Some of these conditions include adverse drug events, pressure ulcers, ventilator associated pneumonia, catheter-associated infections, and air embolisms. Between 2010 and 2013 there was a decline in all categories of HACs.
Hospital readmission within 30-days of being discharged from a hospital stay is not entirely preventable, but can be reduced for certain diagnoses and services. Improvement in this area is often linked to improved quality of care. Medicare 30-day hospital readmission rates have improved about 8 percent from 2007-2013.
Mortality within 30 days of being admitted to a hospital is not entirely preventable, but can be reduced for certain diagnoses. Improvement in this area is often linked to improved quality of care. The 30-day mortality rates for heart attacks (acute myocardial infarction) and ischemic strokes (caused by blood clots) have only slightly improved from 2010 to 2013.
The five-year survival rates for breast cancer and colorectal cancer in the U.S. improved. While mortality rates are used to measure the outcomes for most diseases, the quality of cancer care is often assessed through five-year survival rates. The use of five-year survival rates versus mortality rates has been debated recently, though, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient.
The mortality rate for all cancers (neoplasms) has fallen in the U.S. over the last 30 years. In the U.S., the age-adjusted cancer rate has fallen from about 242 deaths per 100,000 population in 1980 to about 199 per 100,000 in 2010.
The U.S. has made dramatic progress in lowering mortality from diseases of the circulatory system. In the U.S., the mortality rate has fallen from 629 deaths per 100,000 population in 1980 to 265 in 2010.
Mortality rates for respiratory diseases have fallen over the past 10 years.
After rising significantly between 1985 and 1995, mortality rates for these disease have fallen steadily between 1995 – 2010.
People in the U.S. have longer wait times to be seen by a doctor or nurse when they are sick than other comparable countries, with the exception of Canada (as of 2013). The same is not true when seeing a specialist. Along with Switzerland and the U.K., the U.S. has the shortest wait times to see a specialist.