Information Sheet

August 2009

 

NCHS Data on Quality of Care and Patient Safety

 

PDF version (101 KB)

 

About NCHS

The CDC’s National Center for Health Statistics (NCHS) is the nation’s principal health statistics agency, providing data to identify and address health issues.  NCHS compiles statistical information to help guide public health and health policy decisions. Collaborating with other public and private health partners, NCHS employs a variety of data collection mechanisms to obtain accurate information from multiple sources.  This process provides a broad perspective to help us understand the population’s health, influences on health, and health outcomes.

 

Health Care Quality

The Institute of Medicine (IOM) highlighted the “chasm” between the health care delivered in the U.S. and optimal health care in their seminal report in 2006. Their work noted the critical need to change the organization of the U.S. health care system in order to improve the quality of care.  According to the IOM report, providers frequently overuse therapies that are not known to be effective, underuse therapies that are clearly recommended, and misuse therapies.  At best, overuse of care leads to inefficiency and waste.  Overuse may also threaten patient safety.  Underuse represents missed opportunities to prevent disease or treat it effectively, and misuse may threaten patient safety and lead to additional illness, injury, or even death. 

Data from the National Health Care Surveys have been used to identify all three of these threats to quality and patient safety.  These data provide ongoing guidance towards a more effective, efficient, and safer health care system.

 

Key Findings

 

Overuse of health care services

Antibiotic drugs are an excellent example of a health care technology that is subject to overuse.  Antibiotics are essential to medical care.  However, overuse of antibiotics has led to the development of bacteria resistant to antibiotics and infections that are more difficult to treat.   NCHS tracks antibiotic use in physician offices and data from 1980 through 1992 showed increases in antibiotic use at children’s visits to physician offices.  This raised concerns about inappropriate prescribing practices for children.  In the mid-1990s, a series of public health initiatives educated the public and health care providers about judicious use of antibiotics in children.

Source: National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1999-2006.

 

• For children less than 15 years of age, between 1995 and 2006, there was a 21 percent decline (627 to 517 prescriptions per 1,000 children) in the number of antibiotic prescriptions written at physician office visits.
• The rate of antibiotic prescription per physician office visit for children also declined from 284 to 195 per 1,000 office visits for children less than 15 years of age, suggesting that physicians have responded to these initiatives.

 

Underuse of health care services

Wound care programs for pressure ulcers are an example of an important service that is underused by nursing homes.  Pressure ulcers (also known as bed sores) are painful sores that most commonly result from patient immobility.  Once a patient gets a serious ulcer (stage 2 or higher), clinical guidelines call for special wound care treatment to help the wound heal and prevent infection. NCHS data indicate that among nursing home residents in 2004 almost two-thirds of patients with stage 2 or higher ulcers were not enrolled in wound care treatment programs.

 

Misuse of health care therapies

Inappropriate prescribing of drugs to older adults is a critical patient safety issue which may lead to a variety of adverse events such as depression, confusion, and hip fractures. NCHS data show that in 2007, office-based physicians prescribed at least one potentially inappropriate drug at 19 million visits, or 7.4 percent of all visits by adults 65 or older. The updated 2002 Beers criteria defined “potentially inappropriate” as medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they post unnecessarily high risk for persons and a safer alternative is available.

 

Adverse patient outcomes

Data are used to track long-term trends in health care acquired infections among hospital inpatients.  Clostridium difficile is a bacterium that causes intestinal infection, most commonly among hospital inpatients who have been previously treated with antibiotics and is the most commonly recognized cause of antimicrobial-drug associated diarrhea. The National Hospital Discharge Survey show a doubling in reported Clostridium difficile from 2.7 per 1,000 inpatient discharges to 5.1 per 1,000 discharges in 2003.  More recent monitoring indicates that Clostridium difficile infections among hospital inpatients continue to increase.  In 2006, Clostridium difficile infections were reported at a rate of 6.6 per 1,000 inpatient discharges. Possible explanations for these increasing national rates include over use of antibiotics, inadequate infection control practices, an emerging strain with increase virulence and antibiotic resistance, or a combination of these factors.

 

Health Information Technology

With the passage of the American Recovery and Reinvestment Act of 2009, adoption of health information technologies such as electronic health records has been the focus of national attention.  NCHS has been tracking the availability of electronic information systems in physician offices since 2001.  In 2008, a special mail survey was conducted to obtain preliminary estimates of electronic medical record adoption among physicians.

• In the 2008 NCHS mail survey, 17.0 percent of the physicians reported having basic systems, and 4.0 percent reported having fully functional systems. 
• Comparable figures for basic and fully functional systems in the 2006 survey were 10.5 percent and 3.1 percent, respectively.   Notably, some features of electronic information systems are being adopted faster than others. 
• In 2006, 24 percent of physicians had systems to record patient demographics electronically, but only 16 percent had computerized orders for prescriptions.

 

Quality of Care and Patient Safety Data Sources

• National Health Care Surveys – a family of health care provider surveys, obtaining information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.  NHCS surveys hospitals, office-based physician practices, emergency and outpatient departments, ambulatory surgery centers, nursing homes, and home health and hospice agencies.  These surveys provide a picture of how the delivery system works, and provide an opportunity to learn about patients, their illnesses, and treatments.  For more information see the NHCS Website

 

For further information about NCHS and its programs, visit us at NCHS Website, or call the Office of Planning, Budget and Legislation at 301-458-4100.