Peterson-Kaiser Health System Tracker How has the quality of the US healthcare system changed over time?

Peterson-Kaiser Health System Tracker

How has the quality of the US healthcare system changed over time?


Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on September 9, 2015). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding.

Mortality rates have fallen steadily in the U.S. over the past 30 years

Overall age-adjusted mortality rate per 100,000 population

0

200

400

600

800

1000

1200

1400

1184

835


Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on June 25, 2014).

Infant mortality in the United States has improved by about 12% from 2000 to 2011

Infant Mortality, per 1,000 live births 2000 – 2013

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

1

2

3

4

5

6

7

8

6.9

6


Source: Commonwealth Fund, “State Scorecard 2014”For more information: http://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard

Deaths amenable to healthcare in the U.S. have been steadily declining

2002-2003 2004-2005 2006-2007 2009-20100

20

40

60

80

100

120110

9691

86

Amenable mortality per 100,000 population, in years

http://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard


Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on November 6, 2014). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding.

Potential Years of Life Lost have fallen about 37% since 1980

Overall age-specific potential years of life lost per 100,000 population

0

1000

2000

3000

4000

5000

6000

7000

80007345

4629


Source: University of Washington Institute for Health Metrics and Evaluation. For more information see: http://www.healthdata.org/search-gbd-data?s=united%20states

Disease burden has declined from 1990 - 2010

1990 1995 2000 2005 201020,000

21,000

22,000

23,000

24,000

25,000

26,00025,633

24,753

23,276

22,695

21,956

Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 1990, 1995, 2000, 2005, and 2010

http://www.healthdata.org/search-gbd-data?s=united%20states


Source: Kaiser Family Foundations analysis of the Behavioral Risk Factor Surveillance System (BRFSS). *Indicates statistically significant difference between 1996 and 2013.

The percentage of adults reporting poor general health has increased across males and females, whites and Hispanics

Overall* Female* Male* Black (non-Hispanic) Hispanic* White (non-Hispanic)*0%

1%

2%

3%

4%

5%

6%

7%

3.6%3.8%

3.4%

5.2%

4.0%

3.4%

4.8%5.0%

4.5%

5.8%

5.3%

4.5%

1996 2013

Percentage of adults reporting that their general health was poor, by sex and race/ethnicity, 1996 and 2013


Source: Kaiser Family Foundations analysis of the Behavioral Risk Factor Surveillance System (BRFSS). All differences are statistically significant.

The percentage of adults reporting poor physical or mental health in the past month has worsened over time

Poor Physical Health Poor Mental Health Health Prevented Usual Activity0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

31% 31%

38%36%

34%

42%

1996 2013

Percentage of adults reporting that health was not good or prevented usual activities at least one day in the past 30 days due to physical illness and injury, or stress, depression, and emotional problems, 1996 and 2013


Source: Kaiser Family Foundations analysis of the Behavioral Risk Factor Surveillance System (BRFSS). All differences are statistically significant.

The average number of self-reported healthy days per month has decreased slightly over time

Mean number of days in the past 30 days that health was good

Healthy Days (mental and physical)

Good Physical Health Days Good Mental Health Days 21.0

22.0

23.0

24.0

25.0

26.0

27.0

28.0

1996 2013


Source: Commonwealth Fund, “State Scorecard 2014”For more information: http://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard

Screening and preventive care among adults 50 and older has remained fairly static

2006 2008 2010 20120%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

44% 45% 45%42%

Percentage of adults ages 50 and older who received recommended screening and preventive care, in years

http://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard


Source: OECD (2013), "OECD Health Data: Health Care Utilisation", OECD Health Statistics (database). (Accessed on June 9, 2015).

The percent of children receiving recommended doses of vaccines has improved over timePercentage of children ages 12-23 months who received all recommended doses of vaccines for Diphtheria, Tetanus, Pertussis, Measles, and Hepatitis B, in years

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

62.7%

91.7%


Source: Centers for Disease Control and Prevention. National Vital Statistics Reports. “National and State Patterns of Teen Births in the United States, 1940-2013”.For more information: http://www.cdc.gov/nchs/data/nvsr/nvsr63/NVSR63_04.pdf

The teen pregnancy rate has declined 56% from 1991-2014

1991 2005 2007 2009 2010 2011 2012 2013 20140

10

20

30

40

50

60

70

62

4042 40

3431

2927 27

Birth rates per 1,000 women aged 15-19, in years

http://www.cdc.gov/nchs/data/nvsr/nvsr63/NVSR63_04.pdf


Source: Centers for Disease Control and Prevention/National Center for Health Statistics. National Health Examination Survey and National Health and Nutrition Examination Survey.

The prevalence of overweight adults in the U.S. is beginning to decline after increasing for some time

1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-20120%

10%

20%

30%

40%

50%

60%

70%

80%

56.0%

64.5% 65.6% 66.3% 66.9% 68.0% 68.7% 68.5%

Age-standardized prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over, in years


Source: Centers for Medicare & Medicaid Services. Geographic Variation Public Use FileFor more information see: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/

Medicare hospital admissions for ambulatory care-sensitive conditions has decreased about 27%Hospital admissions among Medicare beneficiaries ages 65-74 for ambulatory care-sensitive conditions per 1,000 beneficiaries

2007 2008 2009 2010 2011 2012 20130

5

10

15

20

25

30

35

4037

3634

3332

2927

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/


2005 20100%

10%

20%

30%

40%

50%

60%

70%

80%

66%70%

Source: Agency for Healthcare Research and Quality. “2013 National Healthcare Quality Report.” http://www.ahrq.gov/research/findings/nhqrdr/nhqr13/2013nhqr.pdf

Patients receiving recommended care has improved slightly from 2005-2010

Average proportion of recommended care received across a panel of quality care measures, in years 2005 and 2010


Source: Centers for Medicare & Medicaid Services. "Summary of HCAHPS Survey Results.” Hcahpsonline.org/HCAHPS_Executive_Insight. [01/2007 – 12/2013]. Accessed 2/27/2015.

Staff response to hospitalized patients has improved

2007 2008 2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

62% 62% 63% 64% 65%67% 68%

Percentage of hospitalized patients who reported hospital staff always managed pain well, responded when needed help to get to bathroom or pressed call button and explained medicines and side effects, in years


Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base

More women are receiving biopsy at the time of mastectomy or lumpectomy

Percentage of women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 2004-2011

2004 2005 2006 2007 2008 2009 2010 201185%

86%

87%

88%

89%

90%

91%

92%

93%

94%

95%

88.4%

94.3%


Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program

More people are receiving evidence-based care for heart attack when they arrive at a hospital

Percentage of hospital patients with heart attack given percutaneous coronary intervention within 90 minutes of arrival or fibrinolytic medication within 30 minutes of arrival, United States, 2005-2012

2005 2006 2007 2008 2009 2010 2011 20120%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

42%

95%

38%

62%

Hospital patients with heart attack given percutaneous coronary intervention within 90 minutes of arrivalHospital patients with heart attack given fibrinolytic medication within 30 minutes of arrival


Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program

More patients hospitalized for heart failure are given evidence-based prescriptions at discharge

Percentage of hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed angiotensin-convertingenzyme inhibitor or angiotensin receptor blocker at discharge, United States, 2005-2012

2005 2006 2007 2008 2009 2010 2011 201275%

80%

85%

90%

95%

100%

83%

97%


Source: Centers for Medicare & Medicaid Services. "Summary of HCAHPS Survey Results.” Hcahpsonline.org/HCAHPS_Executive_Insight. [01/2007 – 12/2013]. Accessed 2/27/2015.

More hospitalized patients are receiving instructions for recovery at home

2007 2008 2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

79% 80% 81% 82% 83% 85% 86%

Percentage of hospitalized patients given information about what to do during their recovery at home, in years


Source: Agency for Healthcare Research and Quality. “ Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted from 2010 to 2013.” http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhac2013-ap2.html Notes: Infections include catheter-associated urinary tract infections, surgical site infections, and central line-associated bloodstream infections.

The number of Hospital Acquired Conditions has improved

Adverse Drug Events

Pressure Ulcers All other HACs Infections Falls Obstetric Adverse Events

Ventilator-Asso-ciated Pneumo-

nias

(Post-op) Venous Thromboembolisms

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2010 2013

Number of Hospital Acquired Conditions, 2010 and 2013

http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhac2013-ap2.html




Source: Centers for Medicare & Medicaid Services. Geographic Variation Public Use FileFor more information see: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/

Medicare 30-day hospital readmission rates have declined

2007 2008 2009 2010 2011 2012 20130.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%18.4% 18.5% 18.3% 18.2% 18.1%

17.6%16.9%

Percent of inpatient readmissions within 30 days of an acute hospital stay, among Medicare beneficiaries 65 and older, 2007 - 2013

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/


Source: Centers for Medicare & Medicaid Services. Medicare Hospital Quality Chartbook, September 2014.For more information see: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/Medicare-Hospital-Quality-Chartbook-2014.pdf

Mortality rates within 30 days after hospital admission for AMI, stroke, and pneumonia have decreased

Stroke Acute Myocardial Infarction Pneumonia Heart Failure0

2

4

6

8

10

12

14

16

18

July 2009-June 2010 July 2010-June 2011 July 2011-June 2012 July 2012-June 2013

Hospital-level risk-standardized mortality rates in the 30 days after hospital admission for acute myocardial infarction, strokeheart failure, and pneumonia, in years

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/Medicare-Hospital-Quality-Chartbook-2014.pdf

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/Medicare-Hospital-Quality-Chartbook-2014.pdf


Breast Cancer Colorectal Cancer Cervical Cancer0

1

1

85.4%

61.4%

69.6%

90.0%

66.0%68.9%

1990-1992 2001-2007

Source: Surveillance, Epidemiology, and End Results Program (SEER) http://seer.cancer.gov/archive/csr/1975_2008/browse_csr.php?sectionSEL=5&pageSEL=sect_05_table.08.html (Accessed on August 19, 2015). Notes: SEER 9 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta). Based on follow-up of patients into 2008.

Five-year survival for certain cancers are increasingPercentage of age-adjusted five-year relative survival for breast, colorectal, and cervical cancer, all ages, in years 1990-1992 and 2001-2007



The mortality rate for cancers has been declining

Age-adjusted neoplasms mortality rate per 100,000 population

0

50

100

150

200

250

300

242

203



Mortality rates for diseases of the circulatory system have fallen dramatically over the last 30 yearsAge-adjusted diseases of the circulatory system mortality rate per 100,000 population

19801981

19821983

19841985

19861987

19881989

19901991

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20100

100

200

300

400

500

600

700

629

265



The mortality rate for respiratory diseases has fallen over the past 10 years

Age-adjusted respiratory diseases mortality rate per 100,000 population

19801981

19821983

19841985

19861987

19881989

19901991

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20100

20

40

60

80

100

120

80 82



Mortality rates for endocrine, nutritional and metabolic diseases have fallen over the last 15 yearsAge-adjusted endocrine, nutritional and metabolic diseases mortality rate per 100,000 population

19801981

19821983

19841985

19861987

19881989

19901991

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20100

10

20

30

40

50

60

2834

Documents

Peterson-Kaiser Health System Tracker How has the quality of the US healthcare system changed over time?