Whether they are getting cholesterol and blood pressure levels regularly checked or receiving aspirin when experiencing symptoms of a heart attack, Americans are getting better health care services today than they have in the past. But fewer than half of patients (42%) who smoke and were hospitalized with acute myocardial infarction received counseling to quit smoking while in hospital, and one in five Americans got prescriptions for medications that may have been harmful or inappropriate, a new report released Dec. 22 from the US Department of Health and Human Services (HHS) finds.

Speaking at a news conference to unveil the first annual report on the state of health care quality in the US , Carolyn M. Clancy, MD, director of the US Agency for Health Care Quality and Research (AHRQ), said "we are making progress, but we need to do more."

Using objectives established by HHS' Healthy People 2010 and other national data sources, the report provided data on the quality of and differences in access to care for seven clinical conditions: cancer, diabetes, end-stage renal disease, heart disease, HIV and AIDS, mental health and respiratory disease.

Despite significant progress in treatment of those clinical conditions, opportunities to prevent them from developing into serious illnesses are frequently missed, according to the report. For example, only 42.5% of adults under age 45 are screened for colorectal cancer, while just 53% in the same age group are screened for cholesterol. Despite the well-know link between elevated cholesterol levels and the likelihood of developing heart disease, only 67% of adults have had their cholesterol checked within the past two years and can recall the findings, the report said. About 20% of patients prescribed medication to treat depression have at least three of the recommended follow- up visits to monitor their medication in the 12 weeks after a diagnosis is made.

Not surprisingly, significant variability exists in how chronic diseases are managed, which reduces the potential for good outcomes, the report found. For example, in examining the measures of care for diabetes (annual retinal eye exam, influenza exam, Hba1c, foot exams, and bi-annual lipid profiles), only 20.7% of patients said they had received all five major tests in the past 1 or 2 years.

Both reports are available on a new Web site established by AHRQ: www.qualitytools.ahrq.gov. The site serves as a clearinghouse to make it easier for health care providers and patients to locate information on health care quality.