The Agency for Healthcare Research and Quality (AHRQ) released in December 2003 the first National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) on behalf of the U.S. Department of Health and Human Services (1,2). In this commentary, we summarize the main findings of the reports on preventive care for both primary prevention of disease and secondary prevention of increasing acuity of existing disease and discuss the implications for quality measurement and improvement efforts.

Federal partners within the U.S. health care system have recently focused on increasing the use of preventive care services. Tommy G. Thompson, Secretary of Health and Human Services, issued a challenge in April 2003 at the launch of the Steps to a HealthierUS national initiative:

Good quality preventive care holds the promise of greatly reducing the nation’s health care costs and overall burden of disease. Numerous studies and reports have examined the general quality of preventive care services in the United States (4-7). Others have explored the performance of the U.S. health care system in delivering specific preventive care services such as immunizations (8,9), cancer screening (10-12), and cholesterol and blood pressure screening (13-15).

The NHQR and NHDR provide the first national baseline views of the quality of health care services and of differences in how at-risk groups in America use the services. The reports provide one of the broadest examinations to date of prevention health care quality for the nation and among key priority populations, measuring quality of care across a range of dimensions, including the degree to which care is safe, patient centered, timely, and effectively delivered. They track more than 50 primary and secondary prevention quality-of-care measures in five clinical areas, including cancer, diabetes, heart disease, maternal and child health, and respiratory disease.

Table 1 summarizes the major conclusions of the two reports: the promise of high-quality health care is not a given, gaps in quality are particularly acute for certain racial, ethnic, and socioeconomic groups, and improvement is possible.

The NHQR and NHDR are two of the most comprehensive national assessments of preventive care quality in the United States. They show that the U.S. health care system is missing numerous opportunities to provide evidence-based preventive care and that usage rates for a number of preventive care services are not improving. Significant progress is needed in areas such as colorectal cancer screening, delivery of the full complement of diabetes secondary preventive services, and cessation counseling for smokers, particularly when they are admitted to the hospital for heart attacks.

The purpose of the reports, according to the Congressional mandate that created them, is to document the state of health care quality for the nation. The reports do not address the determinants of health care quality, nor do they prescribe how quality of care could be improved or suggest a national agenda for improving quality. Many public and private entities address these important research, policy, and quality-improvement questions.

The reports contribute to the quality-improvement cycle by providing national information on the state of health care quality, potential benchmarks, and changes that have occurred over time to support a broad community of concerned quality-improvement professionals. Information is critical to helping this broad community understand how gaps and opportunities apply to their own local needs and facilitate their move from data to action. The reports offer more than 525 tables that provide essential information for researchers to analyze the important questions about why performance is the way it is. The reports can help policy makers formulate an agenda for quality by creating understanding about the greatest needs among a wide variety of concerns. Similarly, the reports can serve as a scorecard on the collective performance of all those involved in quality improvement.

In addition to tracking health care quality through the reports, the AHRQ supports quality improvement for the nation by conducting research to determine evidence-based prevention practices, translating research into knowledge, and facilitating the use of knowledge toward the goal of improving the quality of prevention services for all Americans.