2021 National Healthcare Quality and Disparities Report

1 2021. National Healthcare Quality and Disparities Report This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated. Suggested citation: 2021 National Healthcare Quality and Disparities Report . Rockville, MD: Agency for Healthcare Research and Quality ; December 2021. AHRQ Pub. No. 21(22)-0054-EF. Note: As of 2021, the Report year has been changed to reflect the publication year, rather than the year the Report was developed. The Report is published annually, as required by law, but due to the time needed for review, clearance, and production, is released a year after development begins (for example, the 2020.)

2 Report is published in 2021). Because we are using the publication year moving forward, there will not be a Report labeled 2020; the sequence will have a gap, going from 2019 to 2021. 2021 National Healthcare Quality AND. Disparities Report . DEPARTMENT OF. health AND HUMAN SERVICES. Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857. AHRQ Publication No. 21(22)-0054-EF. December 2021. ACKNOWLEDGMENTS. The National Healthcare Quality and Disparities Report (NHQDR) is the product of collaboration among agencies from the Department of health and Human Services (HHS), other federal departments, and the private sector.

3 Many individuals guided and contributed to this effort. Without their magnanimous support, the Report would not have been possible. Specifically, we thank: Primary AHRQ Staff: David Meyers, Jeff Brady, Erin Grace, Karen Chaves, Darryl Gray, Barbara Barton, Romsai Boonyasai, Irim Azam, Cecilia Hahn, and Doreen Bonnett. HHS Interagency Workgroup (IWG) for the NHQDR: Girma Alemu (HRSA), Irim Azam (AHRQ), Andreea Balan-Cohen (IMPAQ), Barbara Barton (AHRQ), Doreen Bonnett (AHRQ), Deron Burton (CDC), Victoria Chau (SAMHSA), Karen Chaves (AHRQ), Xiuhua Chen (Atlas Research), Deborah Duran (NIH- NIMHD), Melissa Evans (CMS), Camille Fabiyi (AHRQ), Darryl Gray, (AHRQ), Kirk Greenway (IHS), Sarah Heppner (HRSA), Ed Huff (CMS), DeLoris Hunter (NIH-NIMHD), Susan Jenkins (ACL), Christine Lee (FDA), Doris Lefkowitz (AHRQ), Jesse Lichstein (HRSA), Lan Liang (AHRQ), Shari Ling (CMS), Iris Mabry-Hernandez (AHRQ), Marlene Matosky (HRSA), Tracy Matthews (HRSA), Christine Merenda (FDA)

4 , Kamila Mistry (AHRQ), Ernest Moy (VHA), Samia Noursi (NIH-NIDA), Kathy O'Connor (CDC), Rajasri Roy (NIH-OD-ORWH), Dianne Rucinski (OASH), Asel Ryskulova (CDC), Adelle Simmons (ASPE), Robin Streeter (HRSA), Loida Tamayo (CMS), Caroline Taplin (ASPE), Emmanuel Taylor (NIH- NCI), Michelle Washko (HRSA), and Ying Zhang (IHS). NHQDR Team: Irim Azam (CQuIPS), Barbara Barton (CQuIPS), Doreen Bonnett (OC), (CQuIPS), Xiuhua Chen, (Atlas Research), James Cleeman (CQuIPS), Camille Fabiyi (OEREP), Erin Grace (CQuIPS), Darryl Gray (CQuIPS), Cecilia Hahn (CQuIPS), Lan Liang (CFACT), Kamila Mistry (OEREP), Margie Shofer (CQuIPS), Abigail Woodroffe (IMPAQ).

5 HHS Data Experts: Cuong Bui (HRSA), Lara Bull (CDC), Robin Cohen (CDC-NCHS), Joann Fitzell (CMS), Elizabeth Goldstein (CMS), Shiromani Gyawali (SAMHSA), Irene Hall (CDC-HIV), Pradip Muhuri (AHRQ), Jessica King (NPCR), Amanda Lankford (CDC), Denys Lau (CDC-NCHS), Lan Liang (AHRQ), Sharon Liu (SAMHSA), Marlene Matosky (HRSA), Tracy Matthews (HRSA), Robert Morgan (CMS), Richard Moser (NIH-NCI), Kathy O'Connor (CDC-NCHS), Krishna Palipudi (SAMHSA), Robert Pratt (CDC), Asel Ryskulova (CDC-NCHS), Alek Sripipatana (HRSA), Reda Wilson (CDC- NCCDPHP-ONDIEH), and Xiaohong (Julia) Zhu (HRSA). Other Data Experts: Mark Cohen (ACS NSQIP), Ashley Eckard (University of Michigan), Sheila Eckenrode (MPSMS-Yale), Clifford Ko (ACS NSQIP), Vivian Kurtz (University of Michigan), Leticia Nogueira (American Cancer Society), Robin Padilla (University of Michigan KECC), Yun Wang (MPSMS-Yale), and Robin Yabroff (American Cancer Society).

6 Other AHRQ Contributors: Cindy Brach, Edwin Lomotan, Karen Migdail, Pamela Owens, Wendy Perry, Mary Rolston, Bruce Seeman, and Michele Valentine. Data Support Contractors: Atlas Research, IMPAQ International. Contents EXECUTIVE SUMMARY ..ES-1. Summary of the Report ..ES-1. Overview of Disease Burden and the Healthcare Access to Healthcare ..ES-1. Quality of Disparities in Healthcare ..ES-3. Key Findings and Trends ..ES-4. OVERVIEW OF Healthcare SYSTEM O-1. Overview of the Healthcare System O-1. Overview of Disease Burden in the United O-3. Overview of Community Hospital Intensive Care O-6. Healthcare workforce .. O-10.

7 Overview of Healthcare Expenditures in the United O-34. Variation in Healthcare Quality .. O-38. Variation in Disparities in Healthcare .. O-40. ACCESS TO Healthcare AND Disparities IN ACCESS .. A-1. health A-3. Dental A-4. Timely Access to Care .. A-5. Perception of A-6. Snapshot of Disparities in Access to Care .. A-9. Disparities in health Insurance .. A-13. Disparities in Dental Insurance .. A-18. Medicare Advantage A-19. Dual-Eligible Beneficiaries .. A-20. Usual Source of A-22. Disparities in Timely Access to Care .. A-24. Perception of A-29. Resources .. A-32. Quality IN Q-1. Trends in Q-2. Trends in Person-Centered Care.

8 Q-3. Trends in Patient Safety .. Q-13. Trends in Care Coordination .. Q-33. Trends in Affordable Q-44. Trends in Effective Q-49. Trends in Healthy Living .. Q-68. Disparities IN D-1. Research Framework for health Disparities .. D-1. Role of Research Framework in the D-2. Racial and Ethnic Disparities .. D-3. Overview of Racial and Ethnic Disparities .. D-4. Disparities for American Indian and Alaska Native Populations .. D-6. Disparities for Asian D-14. 2021 National Healthcare Quality and Disparities Report i Disparities for Black D-23. Disparities for Hispanic D-32. Disparities for Native Hawaiian/Pacific Islander Populations.

9 D-42. Disparities by D-52. Disparities by Insurance Status .. D-67. Disparities by Residence D-79. LOOKING FORWARD ..L-1. Emerging Opportunities for Notable Examples of Collaboration To Improve Healthcare Top Priorities and Tasks at Future Research and REFERENCES ..R-1. APPENDIXES (SEPARATE FILE). Appendix A: Data Sources Used for 2021 NHQDR. Appendix B: Definitions and Abbreviations Used in 2021 NHQDR. Appendix C: Measures Used in the 2021 State Maps ii 2021 National Healthcare Quality and Disparities Report EXECUTIVE SUMMARY. Introduction The National Healthcare Quality and Disparities Report (NHQDR) is sometimes described as a document of record that has summarized the status of health and Healthcare delivery in the United States since 2003.

10 To compile this Report , the NHQDR team prioritizes reporting data and measures that are broadly representative of the performance of the nation's Healthcare system over time. Multiple data partners, including all states and agencies throughout the Department of health and Human Services (HHS), contribute data to the Report . Before the Report is finalized and submitted by the Secretary of HHS to the Congress, the Report undergoes multiple cycles of review by reviewers who include representatives from contributing agencies. Summary of the Report The 2021 NHQDR is organized in sections that provide an overview of the Healthcare system and summarize access, Quality , and disparity measures.