AHRQ Releases 2005 National Healthcare Quality and Disparities Reports

Quality of health care for Americans has continued to improve at a modest pace, and health care disparities are narrowing overall for many minority Americans. But for Hispanics, disparities have widened in both quality of care and access to care, according to reports by HHS’ Agency for Healthcare Research and Quality (AHRQ).

The findings are contained in the 2005 National Healthcare Quality Report and its companion document, the 2005 National Healthcare Disparities Report. These reports, issued annually, measure quality and disparities in four key areas of health care: effectiveness, patient safety, timeliness, and patient centeredness.

The quality report employs a wide range of measures, including health care outcomes such as hospital-acquired infections and reductions in deaths from certain diseases. It also measures how well the health care system is using specific treatments that are known to work most effectively. The disparities report compares these measures by race and ethnicity and by income. It also measures access to care, using indicators such as health insurance status and frequency of visits to a physician. This year, for the first time, the report also shows trends in health care disparities from year to year.

The 2005 National Healthcare Quality Report finds that overall quality of care for all Americans improved at a rate of 2.8 percent, the same increase shown in last year’s report. However, the report notes there has been much more rapid improvement in some measures, especially where there have been focused efforts to improve care.

The 2005 National Healthcare Disparities Report finds that many of the largest disparities in measures of quality and access are observed for low-income people regardless of race or ethnicity, with some signs of improvement. Overall, more racial disparities in quality of care were narrowing than were widening, and most racial disparities in access to care were narrowing (affecting blacks, Asians and American Indians/Alaska Natives). But for Hispanics, the majority of disparities for both quality and access were growing wider.

“The quality report finds modest overall progress in quality of care for Americans and areas where we must continue to work to close health care gaps. Faster progress is especially apparent where focused efforts, including public reporting of quality results, have taken place,” said AHRQ Director Carolyn Clancy, M.D. “It is clear that the need for action to improve quality of care for all Americans continues to be great.”

Examples of findings in the AHRQ disparities report include:

• Rates of late-stage breast cancer decreased more rapidly from 1992 to 2002 among black women (169 to 161 per 100,000 women) than among white women (152 to 151 per 100,000), resulting in a narrowing disparity.
• Treatment of heart failure improved more rapidly from 2002 to 2003 among American Indian Medicare beneficiaries (69 percent to 74 percent) than among white Medicare beneficiaries (73 percent to 74 percent), resulting in an elimination of this disparity.
• The quality of diabetes care declined from 2000 to 2002 among Hispanic adults (44 percent to 38 percent) as it improved among white adults (50 percent to 55 percent).
• The quality of patient-provider communication (as reported by patients themselves) declined from 2000 to 2002 among Hispanic adults (87 percent to 84 percent) as it improved among white adults (93 percent to 94 percent).
• Access to a usual source of care increased slightly from 1999 to 2003 for Hispanics (77 percent to 78 percent) and whites (88 percent to 90 percent), with Hispanics less likely to have access to a usual source of care.

The report finds a 10.2 percent annual improvement in the five core measures of patient safety. These are areas where coordinated national efforts are underway to improve the delivery of specific “best practice” treatments to improve patient safety and reduce medical errors.

“In many areas, we know the specific treatment steps and procedures that are needed to improve quality. These reports indicate that when we focus on those best practices, we can make rapid improvement, especially when results are publicly reported,” Dr. Clancy said.

Improvements were greatest in quality measures for diabetes, heart disease, respiratory conditions, nursing home care, and maternal and child health care. The overall rate of change for these measures was 5.4 percent.

Dr. Clancy said the findings in the report can help target efforts more effectively to improve quality and reduce disparities. “These reports are a complex picture of our progress so far. They can help target where improvement is most needed and help show us how to bring those improvements about,” she said.

The reports were issued today at the National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health, sponsored by the HHS Office of Minority Health. The summit marks the 20th anniversary of the issuance of the Report of the Secretary’s Task Force on Black and Minority Health, which led to new efforts to improve the health and health care of minority Americans.

The AHRQ reports are available online at www.qualitytools.ahrq.gov, by calling 1-800-358-9295 or by sending an E-mail to ahrqpubs@ahrq.gov.

Posted by Dusty Weaver on January 20th, 2006
Posted in: Policy & Advocacy News | No Comments »

PLWC Live Chat: Gastrointestinal Cancers: Scientific News for Patients

Richard Schilsky M.D. will discuss the latest scientific information for patients with colorectal cancer on the People Living With Cancer web site January 26th. The chat will address:

• How to recognize symptoms of gastrointestinal cancer.
• The latest screening and prevention efforts.
• New treatment strategies.
• Treatment for advanced cancer.
• How to manage the side effects of treatment.

There is no cost for the chat which can be joined by going to the PLWC site.

• Gastrointestinal Cancers: Scientific News for Patients
• Richard Schilsky M.D.
• January 26, 2005
• 2:00 – 3:00 p.m. EST

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Posted by Kate Murphy on January 19th, 2006
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Surgery to reduce the risk of cancer in women with Lynch Syndrome

Women with the genetic mutation that causes hereditary colorectal cancer — hereditary non-polyposis colon cancer or Lynch syndrome — are also at increased risk for endometrial and ovarian cancer.  Research reported in the January 19, 2005, issue of the New England Journal of Medicine found that hysterectomy and removing the ovaries reduced the incidence of gynecological cancers in these high-risk women.

Researchers, led by Dr. Karen Lu at M.D. Anderson Cancer Center, identified 315 women who had inherited a mutated gene for Lynch syndrome.  They then matched those who had undergone prophylactic hysterectomy or prophylactic removal of both ovaries with mutation-positive women who had not had protective surgery.  Over the time of the study, no one who had had prophylatic surgery developed endometrial, ovarian, or peritoneal cancer.  However, among the controls 69 women (33%) were diagnosed with endometrial cancer and 12 (5%) with ovarian cancer.

The research team concluded:

These findings suggest that prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome

Lynch Syndrome was first identified by Henry T. Lynch M.D, who is one of the authors of the NEJM article. Also called hereditary non-polyposis colon cancer, a mutated gene directly inherited from a parent increases the lifetime risk of colon cancer to about 80%.  In addition, there is an increased risk of related cancers including endometrial (40% to 60%) and ovarian (10% to 12%).  There is also higher risk of other cancers of the gastrointestinal tract, pancreas, brain, and kidney.

Lynch syndrome is more frequently diagnosed at a young age than non-inherited colon cancer and is associated with a strong family history of colorectal and related cancers.  Diagnosis depends on a identifying one of the mutated mismatch repair genes that fail to repair damaged DNA and allow cells to develop into cancer.

A Lynch syndrome mutation is suspected when

• There are at least 3 directly related family members with colon or a related cancer.
• Cancer occurs in at least 2 generations.
• At least 1 individual is diagnosed under the age of 50.

However, not all colorectal cancer patients with a Lynch syndrome mutation will fit this criteria.  Some researchers are now recommending that people diagnosed with colorectal cancer under the age of 50 have their tumors tested for microsatellite instability, a change in genetic appearance, to screen for possible Lynch syndrome.

Read more about the study on Medpage Today.  Reuters.

Posted by Kate Murphy on January 18th, 2006
Posted in: Research & Treatment News | 1 Comment »

Talk to Congress; OVAC Lobby Day April 25 and 26, 2006

Come to Washington, D.D. to learn about colorectal cancer advocacy and speak up for increased federal funding for cancer research, treatment and screening. C3 advocates will be part of the annual One Voice Against Cancer (OVAC) Lobby Day on Tuesday, April 25th and Wednesday, April 26th, 2006.

• Tuesday morning: C3 Grassroots Connections–learn how to use our tools to make a difference nationally and locally by increasing colorectal cancer awareness, supporting screening legislation and connecting with Congress.
• Tuesday afternoon: OVAC– get the information and skills you need to talk to Congress about funding for cancer research and prevention.
• Wednesday: OVAC–press our case in Congressinal offices using materials and skills from Tuesday.

Advocates participating in the OVAC “Lobby Days” must pay for their own lodging and transportation to Washington, D.C. C3 and OVAC cover the registration fee and training costs.

Congressional visits provide a unique opportunity for advocates to share how cancer has touched their lives. Having strong C3 participation during OVAC Lobby Days helps us educate our policy makers in Washington about the need for additonal research funds for colorectal cancer.

Registration and hotel information will be posted on the C3 web site as soon as it is available. If you have questions or comments about Lobby Day, please contact the C3 office at 202-244-2906 or send an email to the C3 Grassroots Coordinator. You can also go to the C3 Advocates in Action message board to participate in discussions about Lobby Days and other advocacy issues.

Posted by Dusty Weaver on January 18th, 2006
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Analysis of sentinel nodes fail to predict positive lymph nodes in colon cancer

Cancer cells in the regional lymph nodes that drain directly from the colon are important to staging colon cancer and estimating the risk of recurrence after surgery.  Sentinel nodes are the first nodes leading from the tumor.  In other cancers, particularly breast cancer, examining the sentinel node reliably predicts whether or not cancer has spread to the remaining nodes.

Researchers from the Cancer and Leukemia Group B identified and removed both sentinel nodes and non-sentinel regional lymph nodes during surgery to remove primary colon cancers.  They injected a blue dye into the tumor and observed its flow to identify the sentinel node.

However, it was not possible to use the sentinel node to predict whether cancer cells (micrometastatic disease) was present in other nearby lymph nodes.  Sentinel nodes failed to predict further positive nodes in 13 of  24 (54%) of node-positive patients. 

Writing in the Journal of Clinical Oncology published early online on January 17, 2005, the team concluded:

By examining both SNs and non-SNs, this multi-institutional study showed that SNs did not accurately predict the presence of either conventionally defined nodal metastases or MMD. As a result, SLNS is not a useful technique for the study of MMD in patients with colon cancer.  

Posted by Kate Murphy on January 18th, 2006
Posted in: Research & Treatment News | No Comments »