**Write FOUR 50-100 word replies to the Four (4) individual discussion responses ** There should be 4 different posts. Each post is numbered and has a name.
APA 7 format.11 pt. Calibri font., with proper in-text citations- if needed. Please provide a copy of all references, A.I., and plagiarism reports.
The primary post(s) are provided as an attached file.
Assignment Details:
To help you with your discussion, please consider the following questions:
What clarification do you need regarding the posting?
What differences or similarities do you see between your posting and other classmates' postings?
What additional questions do you have after reading the posting?
What item you found to be compelling and enlightening.
PART 1
Initial Question: Read this article about brand equity .
The article provides an overview of this concept. It also presents two examples of companies with high brand equity near the end of the article.Please discuss the following with your fellow classmates:
· Select 1 of the brands from the article that has the highest brand equity (the most important) to you.
· What made you select that brand?
Respond to at least 2 of your fellow classmates with at least a 50–100-word reply about their Primary Task Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following questions:
· What did you learn from your classmate's posting?
· What additional questions do you have after reading the posting?
· What clarification do you need regarding the posting?
1. Student Post to Respond to: Sandi Roberts
When I did a google search about companies that have brand equity I decided to choose Starbucks. I feel like Starbucks is a good example of a company that has a high brand equity. They are the largest coffee chain internationally. They have built their brand with a great atmosphere, constant new limited-edition drinks, new cups. They went through many changes over the years. Most I will honestly say I do not even remember what happened. Like for instance before 2018 they were Starbucks Coffee. During 2018 They changed the logo to just Starbucks. A change that never even crossed my mind. The company did it in a way that no one was confused by the change so some like me may not have noticed the change. The reason they did that was because they did not want to be locked down by the word coffee. Which is a very smart move on their part. You do not have to be a coffee drinker to enjoy Starbucks. With the non-coffee drinks, pastries, breakfast croissants, cake pops and let us not forget about the good ole Pup Cup if you are someone who brings your dog with you.
I cannot really say that Starbucks was the most important to me necessarily, but it was fitting for this assignment and had all the info I needed in one article I found. Yes, I do love Starbucks, but I also do not go there all the time either. Maybe if I ever could leave for work early I would lol. They are a good brand with good customer service. They check all the boxes in my opinion.
2. Student Post to Respond to: Tristan Riffe
This discussion board we are talking about brand equity. A quick summary of brand equity is how recognizable your brand is and what the general experiences associated with your brand or company. I have had some really good experiences with several brands in my life, but most recently I nave been shopping at Costco and wanted to talk about Kirkland Signature. Kirkland's mission statement is "we believe in providing customers with everything they need to create inspirational living spaces, but we also believe in living inspirational lives." If you have ever been to Costco you would know just how many products Kirkland offers. They have everything from food products all the way to baby essentials.
The reason I picked Kirkland Signature was because of their variety, but also because of their ability to compete with big name brands and offer more affordability. At my local Walmart for a 70 Fl. oz bottle of dish soap costs 9.94$. At my Costco I can buy a 90 Fl. oz bottle of dish soap for the same price! and it goes further than just cleaning essentials. I don't buy my dog food at a big name store but comparing the prices of 35 lbs of dog kibble at Walmart it cost 74 $ to Costco's cost of 53$. Although you need a membership to shop at Costco I find the 65 $ annual cost to be very worth it, and don't get me started on the chicken bake.
PART 2
1 . Initial Question: Review and reflect on the knowledge that you have gained from this course. Based on your review and reflection, write at least 3 paragraphs on the following:
· What were the most compelling topics learned in this course?
· How did participating in discussions help your understanding of the subject matter? Is anything still unclear that could be clarified?
Respond to at least 2 of your fellow classmates with at least a 50–100-word reply about their Primary Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following question:
3. What did you learn from your classmate's posting?
4. What additional questions do you have after reading the posting?
5. What clarification do you need regarding the posting?
1. Student Post to Respond to: Melissa Hurley
In Introduction to Marketing, I feel it covered fundamental concepts related to promoting products and services. Marketing is much more than that. It encompasses a variety of channels, tactics, and formats.
Content Marketing: This strategy involves creating valuable content to engage your audience naturally. It's a long-term investment that builds brand awareness and nurtures customer relationships.
The entire premise of content marketing is to provide valuable content to your audience. This can be blog posts, videos, podcasts, e-books, and more. Unlike a pop-up ad, this type of marketing isn't disruptive. It's supposed to feel natural, organic, and helpful. Content marketing is a long-term investment. But with patience and the right strategy, you can drive brand awareness and nurture customer relationships without significant financial strain.
Email Marketing: Reach people who’ve already shown interest in your business. Set up trigger emails based on actions (purchases or content downloads) to promote products and share offers.
Email marketing is relatively affordable compared to other marketing channels. Many email service providers offer free plans or tiered pricing to appeal to different budgets. With email marketing, you reach people who’ve already expressed an interest in your business. This puts you in a great position to build relationships, promote your products, and share offers. You can also set up trigger emails when someone completes an action, such as making a purchase or downloading a content offer.
Social Media Marketing: Establish a presence by sharing content on platforms like Facebook, Instagram, and LinkedIn. Interact with customers and leverage user-generated content to foster relationships and build brand loyalty.
These days, consumers expect brands to have an online presence so if you haven't already, sign up for a business profile on a few social media sites. Once you're up and running, you can begin to share content. Experiment with different types of content until you have a better idea of what gets the most traction. Remember that social media is all about connection, so interact with customers, initiate conversations, and leverage user-generated content. These tactics can help you foster relationships and build loyalty around your brand without spending a dime. However, if you decide to run paid ads, social media offers incredible reach that can generate immediate results. Platforms like Facebook, Instagram, Twitter, and LinkedIn provide advanced ad targeting, enabling you to narrow down your audience based on demographics, interests, and behaviors. With flexible budgeting options, you can allocate your budget strategically and maximize your ROI.
I feel that participating in discussions helped me to understand the subject matter by gaining other points of view. This course covered a major of learned topics in our discussions, in one form or another. I feel each discussion gave me another viewpoint to learn from. We all learn and see topics differently. The discussions gave me more learning with each post I read.
2. Student Post to Respond to: Kathleen Harris
For me one of the more interesting explorations was finding out about the four P's of marketing-product, price, place, and promotion, also known as a marketing mix. When the concept was introduced, it helped companies overcome physical barriers that could hamper widespread product adoption. Now today we have the Internet availability which has helped businesses to overcome those barriers. A successful marketing strategy must be revisited from time to time, it, needs to be adjusted and tweaked as a product grows and a customer base changes. I love that the marketing campaign starts with an understanding of the product. Who needs it and why. What special features might it have that a competitor company is lacking? Earlier I told about the stove that my sister and I purchased and what features it had. The two things that won us over were number one it had a built in air fryer, and number two, a warming spot on it. It didn't hurt it that is also uses steam to clean itself instead of harsh chemicals being used. As of this evening we have not yet clean it so I'm really not sure yet how that will go. I enjoyed my classmates stories and it helped toward motivating me to do well. Thank you everyone.
**Write FOUR 50-100 word replies to the Four (4) individual discussion responses ** There should be 4 different posts. Each post is numbered and has a name.
APA 7 format.11 pt. Calibri font., with proper in-text citations- if needed. Please provide a copy of all references, A.I., and plagiarism reports.
The primary post(s) are provided as an attached file.
Assignment Details:
To help you with your discussion, please consider the following questions:
What clarification do you need regarding the posting?
What differences or similarities do you see between your posting and other classmates' postings?
What additional questions do you have after reading the posting?
What item you found to be compelling and enlightening.
PART 1
Initial Question: Watch this commercial before completing the assignment.
When you have finished watching the commercial, please discuss the following with your classmates:
Identify which of the four Ps of marketing is the most important to you.
Describe how this commercial made you feel. Was it effective?
Respond to at least 2 of your fellow classmates with at least a 50–100-word reply about their Primary Task Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following questions:
· What did you learn from your classmate's posting?
· What additional questions do you have after reading the posting?
· What clarification do you need regarding the posting?
1. Student Post to Respond to: Dominique Duggins
The perfect P's as i call them all have their own great purpose we all can agree on that. Without the ideal product what would you sell? But, to me promotion is "Everything". Promoting is the most important to me, because it is what draws the customers attention. In the video the twins showed kindness to one which made another want to do the same thing for someone else. In the world now a days being kind is a high standard for gaining respect. Customers love to see how a franchise or an up and coming one will affect the community hoping for just what was displayed in the video. I believe that the way they promoted their company through showing kind gestures made me feel like good people still do exist. Besides me wanting to eat their food, it makes me want to give back a little more so my love for human race and the well being of others. See how promotion is the most effective it drawled you in, contributed to emotions, also created a sense of comfortability. Overall it was very effective i forgot about the product a little I was more into the hospitality, but being in a restaurant setting feeling like at home will make you come back every time.
2. Student Post to Respond to: Quinetra Allen
Out of the four Ps of marketing the one that’s most important to me is Promotion. I feel like what you put out is what you get. How can you successfully encourage others to even look at your product without putting it out there to get the exposure it deserves. You must promote your product to introduce it by informing, educating, and even entertaining the customers. Promoting your product is spreading the word about it to get customers onboard with knowing the product. When promoting it’ll bring it back to the marketing mix such as describing and showing the product itself, letting the consumers know where exactly this product can be found and purchased at its price. Without promoting you can’t have the marketing mix in my opinion. This is my take on why promotion is the most important out of the Ps of marketing to me. The product would be irrelevant without the proper communications about it.
The Chic-fil-a commercial made me feel like warm. Chic-fil-a took a little boy’s dream and made it a reality because he wanted to do something for a greater cause on his birthday. It made me feel like the company is a great company and what they do is positive for the community. It’s a great feeling to know that the company values their customers and the community.
PART 2
1 . Initial Question: Watch this video for more information about features and benefits .
Choose a product that you recently purchased, reflect on its features and benefits, and then discuss the following with your fellow classmates: Describe the features of the product that you purchased. Identify the benefits important to you in making this purchase.
Respond to at least 2 of your fellow classmates with at least a 50–100-word reply about their Primary Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following question:
2. What did you learn from your classmate's posting?
3. What additional questions do you have after reading the posting?
4. What clarification do you need regarding the posting?
1. Student Post to Respond to: Alexis Dill
I’m recently a new mom so recently I been buying a lot of new cool baby gadgets. My most recent purchase was a baby bouncer activity center fun set. It’s meant to help with baby development and activities to keep the baby occupied. Some of the features are:
· Infant jumper and activity center with lights, music , and sounds with toys.
· Seat spins for 360 degrees so baby can play with all the attached toys including a teether , rattle ball roller , mirror and attached blocks.
· Some removable toys to help with baby sensory.
· You can adjust the set with 3 different heights so the activity set grows with baby.
· You can remove the cloth from the seat making it easy to wash.
In all baby can have fun will learning new motor skills. The major benefit of this product is that, although my son is having fun bouncing and playing in the activity set he’s also developing motor skills. It also a great workout normally after my son is in activity set he wants to take a nap after. Also another great benefit is that attached are teething toys and my son is teething so it helps soothes his gums while playing. The major benefits is he develops gross motor skills , sensory skills and helps me out when I need to do things around the house this set keep him occupied.
2. Student Post to Respond to: Debbie Poe
Product: Treseme shampoo and conditioner, Benefits/Features: Repairs your damaged hair, keeps colored hair lasting longer, helps maintain colored treated hair, and replenishes natural minerals and vitamins in your hair. It has a frizz control formula and helps make hair silky smooth. Treseme is decently priced and is found in most of the stores near me. Treseme offers several types of shampoos and conditioners to meet each individual customer's needs or wants.
For me personally, when buying any type of shampoos, conditioners, or any hair care product, I must be careful due to extremely sensitive skin and scalp. I want and need a hair product that is not going to irritate my skin and scalp. Finding a hair product that meets these needs, wants, and my sensitive skin is necessary. I use lots of things that cause damages to my hair like straightening my hair with a hair straightener, blow drying my hair with blow dryer, I use curling irons and crimpers to curl and crimp my hair, hair products like moose, hair spray and gel, and I dye my hair on a regular basis, doing all these things cause lots of damages and harm to my hair. The type of shampoo and conditioner that I buy, and use helps replenish all the vitamins and minerals that are stripped aways in my hair. Treseme keeps my hair soft, silk, full, tangle free, replenishes vitamins and minerals, repairs and helps prevent dead ends. Treseme also works great in the whole family's hair including the kid's hair. Since switching to treseme shampoo and conditioner, I no longer must spend extra money on detangler spray or fancy hair products to help heal or revive my hair. It is decently priced, found in all the stores around where I live, and has several types to meet all types of hair.
- Read the Executive Summary
- Browse the rest of the report
- Based on your brief review of this report, summarize the state of healthcare quality and disparities in the United States in one or two paragraphs and identify opportunities for improvement of the current state of healthcare quality in the U.S.
2023
National Healthcare Quality and Disparities Report Executive Summary
This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated.
Suggested citation: 2023 National Healthcare Quality and Disparities Report. Executive Summary. Rockville, MD: Agency for Healthcare Research and Quality; December 2023. AHRQ Pub. No. 23(24)-0091-EF.
2023 NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT Executive Summary
U.S. DEPARTMENT OF HEALTH ANDHUMAN SERVICES Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov
AHRQ Publication No. 23(24)-0091-EF December 2023 https://www.ahrq.gov/research/findings/nhqrdr/index.html
Acknowledgments The National Healthcare Quality and Disparities Report (NHQDR) is the product of collaboration among agencies from the U.S. Department of Health and Human Services (HHS), other federal departments, and the private sector. 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: Robert Valdez, Craig Umscheid, Erin Grace, Karen Chaves, Darryl Gray, Barbara Barton, Romsai Tony Boonyasai, Cecilia Hahn, and Doreen Bonnett.
HHS Interagency Workgroup (IWG) for the NHQDR:, Girma Alemu (HRSA), Anne-Marie Gomes (SAMHSA), Jill Ashman (CDC), Elizabeth Barfield (NIH), Barbara Barton (AHRQ), Doreen Bonnett (AHRQ), Romsai Tony Boonyasai (AHRQ), Christopher Cairns (CDC), Victoria Chau (SAMHSA), Karen Chaves (AHRQ), Xiuhua Chen (CVP), Robin Cohen (CDC), Nathan Donnelly (SAMHSA), Deborah Duran (NIH), Melissa Evans (CMS), William Freeman (AHRQ), Sabrina Frost (HRSA), Darryl Gray (AHRQ), Kirk Greenway (IHS), Monika Haugstetter (AHRQ), Rebecca Hawes (NIH), Kirk Henry (CDC), Sarah Heppner (HRSA), Trevor Hsu (SAMHSA), Heydy Juarez (SAMHSA), Christine Lee (FDA), Doris Lefkowitz (AHRQ), Lan Liang (AHRQ), Jesse Lichstein (HRSA), Shari Ling (CMS), Iris Mabry-Hernandez (AHRQ), Marlene Matosky (HRSA), Tracy Matthews (HRSA), Donna McCree (CDC), Christine Merenda (FDA), Kamila Mistry (AHRQ), Dawn Morales (NIH), Ernest Moy (VHA), Pradip Muhuri (AHRQ), Sarada Pyda (ASPE), Mary Roary (SAMHSA), Rajasri Roy (NIH), Dianne Rucinski (CMS), Asel Ryskulova (CDC), Michelle Schreiber (CMS), Yahtyng Sheu (HRSA), Adelle Simmons (ASPE), LaQuanta Smalley (HRSA), Loida Tamayo (CMS), Caroline Taplin (ASPE), Anjel Vahratian (CDC), Michelle Washko (HRSA), Tracy Wolff (AHRQ), Abigail Woodroffe (AIR), Ying Zhang (IHS), and Rachael Zuckerman (ASPE).
NHQDR Team: Barbara Barton (CQuIPS), Doreen Bonnett (OC), Romsai Tony Boonyasai (CQuIPS), Xiuhua Chen, (CVP), William Freeman (OEREP), Erin Grace (CQuIPS), Darryl Gray (CQuIPS), Cecilia Hahn (CQuIPS), Lan Liang (CFACT), Kamila Mistry (OEREP), Margie Shofer (CQuIPS), Andrea Timaskenka (CQuIPS), Tselote Tilahun (CQuIPS), and Abigail Woodroffe (AIR).
HHS Data Experts: Cuong Bui (HRSA), Lara Bull-Otterson (CDC), Christopher Cairns (CDC), Robin Cohen (CDC-NCHS), Joann Fitzell (CMS), Elizabeth Goldstein (CMS), Irene Hall (CDC-HIV), Katrina Hoadley (CMS), Jessica King (CDC), Amanda Lankford (CDC), Lan Liang (AHRQ), Lori Luria (CMS), Marlene Matosky (HRSA), Anthony Oliver (CMS), Tracy Matthews (HRSA), Robert Morgan (CMS), Richard Moser (NIH-NCI), Pradip Muhuri (AHRQ), Robert Pratt (CDC), Asel Ryskulova (CDC-NCHS), LaQuanta Smalley (HRSA), Alek Sripipatana (HRSA), Rita Wilson (EPA), and Xiaohong (Julia) Zhu (HRSA).
Other Data Experts: Valarie Ashby (University of Michigan), Mark Cohen (ACS NSQIP), Sheila Eckenrode (QSRS-Yale), Clifford Ko (ACS NSQIP), Jill McCarty (IBM), Joe Messana (University of Michigan), Tammie Nahra (University of Michigan), Leticia Nogueira (American Cancer Society), Robin Padilla (University of Michigan), Rebecca Anhang Price (RAND), Jennifer Sardone (University of Michigan), Yun Wang (QSRS-Yale), and Robin Yabroff (American Cancer Society).
Other AHRQ Contributors: Ashley Allman, Cindy Brach, Howard Holland, Edwin Lomotan, Corey Mackison, Karen Migdail, Milli O’Brien, Pamela Owens, Mary Rolston, Ruby Sachdeva, Bruce Seeman, and Michele Valentine.
Data Support Contractors: AIR, CVP Corp.
2023 National Healthcare Quality and Disparities Report 1
Executive Summary The United States is a global leader in scientific discovery and developing innovative technologies to diagnose and treat disease. Health professionals, provider organizations, health insurance plans, and other diverse entities bring those advancements to people. But the various healthcare systems often emerged at different points in our nation’s history, under varied contexts and for different purposes. Thus, they were not always designed to function as a single, coherent system. But it is essential that they work together to ensure that the benefits of science and innovation reach all Americans.
Since 2003, the Agency for Healthcare Research and Quality’s (AHRQ) National Healthcare Quality and Disparities Report (NHQDR) has summarized the status of healthcare delivery in the United States, providing a statistical portrait of how effectively healthcare delivery systems provide safe, high-quality, and equitable care to Americans. At its core, the NHQDR asks: How successful are the nation’s healthcare systems in ensuring that all people benefit from the scientific advancements and treatments available today?
Many partners, including Department of Health and Human Services (HHS) agencies and health officials from all U.S. states, contribute data for the report, which the Secretary of HHS delivers to Congress annually as mandated by law. The 2023 NHQDR examines the data in three sections:
• Portrait of American Healthcare provides an overview of healthcare delivery systems. It characterizes the U.S. population, their leading health concerns, the main components of healthcare delivery, and the nation’s capacity to deliver services to the population.
• Special Emphasis Topics are focused data briefs that examine quality and disparities in healthcare. This year’s special emphasis topics explore the nation’s experiences with COVID-19 healthcare delivery from five perspectives: the U.S. population, hospitals, ambulatory care settings, nursing and residential care facilities, and telehealthcare.
• Quality and Disparity Tables provide statistical assessments of healthcare delivery performance in eight topic-elated areas through the application of more than 550 quality measures.
Portrait of American Healthcare: Key Findings Demographics
• The U.S. population is aging. The number of people age 65 and over increased from 40.2 million to 55.9 million between 2010 and 2021, or from 13.0% to 16.8% of the population. Currently, there is one adult age 65 or over for every three working age adults; the Census Bureau projects that there will be two older adults for every three working age adults by 2060.
■ This trend has important implications for healthcare delivery because older adults are more likely to have chronic conditions; mental disorders, including cognitive limitations; and physical disabilities. A higher ratio of older adults to working age adults raises concern that the number of people who need healthcare services will exceed the number available to provide care.
■ Healthcare delivery systems can respond to this demographic concern by pursuing approaches that promote “heathy aging.” Such approaches include preventing chronic
Executive Summary
2 2023 National Healthcare Quality and Disparities Report
diseases, addressing chronic conditions early so they do not lead to disability, and enabling people with disabilities to participate more fully in society.
• The population has become more diverse racially and ethnically. Non-Hispanic (NH) White people accounted for a smaller share of the population in 2020 (57.8%) than in 2010 (63.7%). At the same time, Hispanic (16.3% to 18.7%), NH-multiracial (1.9% to 4.1%), and NH-Asian (4.7% to 5.9%) people increased as a share of the population. ■ The change in racial and ethnic diversity has occurred largely in younger age groups. For
example, 92.2% of Hispanic, 94.0% of NH-multiracial, and 86.8%% of NH-Asian people are under age 65.
■ In contrast, only 79.0% of NH-White people are age 65 years or younger.
This trend suggests an increased need for more culturally and linguistically appropriate services for pediatric care, obstetric care, and mental health care, among others.
• More people are living in metropolitan areas. The population in both metropolitan and nonmetropolitan counties grew between 1990 and 2020, but it grew faster in metropolitan areas. Large central metropolitan areas (“cities”) grew by 32.0%, large fringe metropolitan (“suburban”) counties grew by 52.7%, micropolitan (“small town”) counties grew by 14.5%, and noncore (“rural“) areas grew by 5.7%. Therefore, healthcare services have declined in many nonmetropolitan areas, even as services in metropolitan communities have grown. However, substantial numbers of people (46 million, or 13.9% of the population) still live in nonmetropolitan counties, resulting in a healthcare access crisis for some people in those communities.
Leading Health Concerns • In 2021, overall life expectancy decreased for the second year in a row, further expanding a
life expectancy gap between U.S. residents (76.1 years) and people who live in peer countries, including Japan (84.5 years), Switzerland (84.0 years), Australia (83.4 years), Sweden (83.2 years), France (82.5 years), Belgium (81.9 years), the Netherlands (81.5 years), Austria (81.3 years), Germany (80.9 years), and the United Kingdom (80.8 years).
• The leading contributors to the drop in life expectancy in 2021 were COVID-19 (which contributed 50% of the decrease in life expectancy), unintentional injuries (15.9%, a plurality of which were drug overdose), heart disease (4.1%), liver disease (3.0%), and suicide (2.1%). The decrease in life expectancy would have been even greater except that deaths due to homicide, influenza and pneumonia, congenital malformations, and perinatal events decreased in 2021 compared with historical trends.
• Substantial disparities in life expectancy exist among people of different racial and ethnic backgrounds. NH-Asian people had the highest life expectancy in 2021 (83.5 years), followed by Hispanic (77.7 years), NH-White (76.4 years), NH-Black (70.8 years), and NH- American Indian or Alaska Native (AI/AN) (65.2 years) people. For comparison, the average life expectancy for peer countries in 2021 was 82.4 years.
• All racial and ethnic groups experienced substantial loss of life expectancy during the COVID- 19 public health emergency (PHE) . Between 2019 and 2021, NH-AI/AN communities suffered the greatest loss in life expectancy (-6.6 years, a 9.2% decline), followed by Hispanic (-4.2 years, 5.1% decline), NH-Black (-4 years, 5.3% decline), NH-White (-2.4 years, 3.0%
Executive Summary
2023 National Healthcare Quality and Disparities Report 3
decline), and NH-Asian (-2.1 years, 2.5% decline) people. For comparison, the average loss of life expectancy in peer countries during COVID-19 was -0.2 years, a 0.2% decline.
Social Determinants of Health • Social determinants of health, (social, economic, environmental, and community conditions)
often have a stronger influence on the population’s health and well-being than services delivered by practitioners and healthcare delivery organizations. They also influence the extent to which people use healthcare services and how well they respond to treatment and recover from illness.
• One of the most important social determinants of health is having health insurance. The percentage of people under age 65 years with health insurance coverage continued to increase in 2021. Between 2020 and 2021, the percentage of Americans with private health insurance coverage increased 1.1%, and the percentage of those with public insurance increased 0.2%. However, insurance coverage varied by state and by race and ethnicity. States ranged between providing health insurance coverage to as many as 96.7% of their populations to as little as 77.6% of their populations. Hispanic and NH-AI/AN populations are less likely to have any health insurance coverage compared with other racial and ethnic groups.
Healthcare Delivery Systems • Healthcare delivery systems are sectors of the healthcare industry that perform distinct but
overlapping functions. They include healthcare workers and resources, as well as organizations, such as outpatient medical offices, clinical laboratories, pharmacies, home and community-based services, hospitals, and nursing and residential care facilities. Americans receive healthcare services from a diverse range of healthcare delivery systems. (As a concept, “healthcare delivery systems” are distinct from “health systems,” which are networks of healthcare entities that share a central organizational structure, such as a network of medical offices and community hospitals anchored by a tertiary care academic hospital.)
• The number of healthcare workers decreased sharply during the COVID-19 PHE. As of January 2023, overall healthcare workforce participation has returned to levels reported in January 2020. The recovery, however, has varied by healthcare setting and by occupation.
■ Although the population is aging and demand for long-term services and supports has grown, the nursing and residential care facilities workforce shrank during the COVID-19 PHE. In January 2023, there were 8.4% fewer nursing and residential care workers than in January 2020. In contrast, the number of “employed and at work” hospital and ambulatory care workers has returned to or surpassed prepandemic levels.
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4 2023 National Healthcare Quality and Disparities Report
■ Although a potential shortage of nurses and doctors has received much attention, the total number of physicians and nurses employed and at work was stable between January 2020 and December 2022. However, the number of workers employed in occupations requiring an associate’s degree or less education (medical assistants, phlebotomists, etc.) decreased from 2.26 million workers in January 2020 to a low of 1.55 million workers in April 2020, before partially recovering to 2.15 million workers as of December 2022. The data suggest that a widely reported shortage of healthcare workers may be driven by loss of workers in occupations that required less educational attainment for entry, many of whom have employment options beyond healthcare.
• Many rural Americans lack access to primary care services, and the primary care providers who are available are often isolated from their professional peers. The Health Resources and Services Administration (HRSA) has designated more than 63% of U.S. counties as “whole county” primary care health professional shortage areas (HPSAs), indicating areas where lack of primary care practitioners threatens access to needed services. Of these 71.7% are rural and micropolitan (i.e., small town) counties.
• Many rural Americans also lack access to hospital care, as 174 rural hospitals closed (i.e., either closed completely or stopped offering inpatient services while continuing to provide other healthcare services) between 2005 and 2020. The pace of rural hospital closures slowed during the COVID-19 PHE, with 2 closures in 2021 and 6 closures in 2022, compared with an annual average of 13.8 closures per year in the preceding 5 years. The slowdown occurred after passage of several federal COVID-19-related bills, which included temporary financial support for at-risk hospitals.
• Nearly one-fifth of the population has provided unpaid long-term and postacute care for a loved one instead of using a formally recognized healthcare establishment. This estimate reflects the growing share of the population that relies on long-term and postacute care services. The long-term and postacute care sector that seeks to address this need is fragmented and consists of many different types of healthcare delivery organizations and varying levels of government support and health insurance coverage.
National Health Expenditures • Where a nation spends its limited resources often reflects its needs and priorities. The
National Healthcare Expenditures provide a financial accounting of healthcare spending. • National healthcare consumption represents the sum of all spending for medical care services
plus governmental health administration and public health activities. As a share of national healthcare consumption, out-of-pocket spending has decreased, correlating with an increase in spending by publicly sponsored health insurance (Medicare and Medicaid). In 2021, publicly sponsored health insurance accounted for 40.4% of all healthcare consumption. Private health insurance accounted for 29.9%, and out-of-pocket spending accounted for 10.7%.
• Spending on public health activities, which includes worksite and school-based healthcare services, maternal and child health programs, the Indian Health Service, HRSA’s Health Center program, and many other federal programs, declined from 18.0% to 12.4% of national health consumption between 1960 and 2019. During the COVID-19 PHE, spending on public health and other federal health programs increased to 19.0% of national health consumption in 2020 before decreasing to the most recent estimate of 14.7% in 2021.
Executive Summary
2023 National Healthcare Quality and Disparities Report 5
• Personal healthcare expenditures represent all spending for medical goods and services, excluding government administration and public health activities. They show the nation is transitioning from hospital-based care toward delivering medical services in nonacute care settings.
■ Hospitals’ share of personal health expenditures peaked at 47.8% in 1982. Since then, it has decreased steadily to 37.7% in 2021.
■ During the same period, spending for services typically delivered in nonacute care settings and people’s homes replaced hospital’s share of personal healthcare expenditures. These include increased spending between 1982 and 2021 for prescription drugs (5.4% to 10.6%); home care (1.2% to 3.5%); nonphysician professional care, such as physical therapists and home health aides (1.8% to 3.7%); and durable and nondurable medical equipment, such as wheelchairs, nebulizers, and home oxygen (8.7% to 10.9%).
Geographic Variations in Care • Overall quality of care varied among states. Four states in the Northeast region (Maine, New
Hampshire, Pennsylvania, and Rhode Island), five in the Midwest region (Iowa, Minnesota, Nebraska, South Dakota, and Wisconsin), one state in the South region (Delaware), and two states in the West region (Idaho and Utah) had the highest overall quality scores.
• There also were differences in quality of care by race and ethnicity among states. Five states in the West region (Hawaii, Idaho, Montana, Oregon, and Washington), four states in the South region (Arkansas, Kentucky, Virginia, and West Virginia), and two states in the Midwest region (Kansas and Nebraska) had the fewest racial and ethnic healthcare disparities overall.
Special Emphasis Topics: Key Findings The 2023 NHQDR includes an Overview that describes SARS-CoV-2 and the biologic and clinical considerations that enabled this virus to cause the disease COVID-19. Five other sections examine how the COVID-19 pandemic affected U.S. healthcare delivery from the perspectives of five groups within the healthcare delivery system. Highlights from each are below.
Impact of COVID-19 on the U.S. Population This topic examines the population’s experience during the COVID-19 PHE, which varied across regions and communities due, in part, to the way that SARS-CoV-2 first affected densely populated coastal cities before spreading to suburban, rural, and remote communities. Nationally, COVID-19 death rates increased between the pandemic’s first and second years, despite the nation having more knowledge about the disease and greater availability of testing, treatments, and vaccines.
Two types of factors drove the rise in COVID-19 death rates:
• First were factors that enhanced risks of getting infected. These included the emergence of variants with higher transmissibility, relaxation of public health initiatives that had limited exposure to the virus, and varying use of COVID-19 vaccines.
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6 2023 National Healthcare Quality and Disparities Report
• Second were factors that enhanced risk of dying if infected. These included higher lethality of some SARS-CoV-2 variants, case surges that reduced hospital capacity and reduced access to appropriate treatment, and variable use of COVID-19 vaccines.
Healthcare delivery systems, such as hospitals, nursing homes, pharmacies, home and community-based service providers, and medical offices, had crucial roles mitigating both types of risks. They performed essential functions such as conducting surveillance testing, educating the public, and distributing vaccines. Healthcare delivery systems helped because the public health system lacked the resources to deliver these services at the scale needed for a global health crisis such as COVID-19 without health systems’ involvement.
Despite limited vaccine availability in the early months of 2021, the combined efforts of the public health and healthcare delivery systems successfully achieved vaccination levels that were initially expected to confer population immunity. However, populations lacking health insurance, living in low-income communities, and living in rural locations were less likely to receive counseling to get the vaccine and less likely to receive it. As these groups often lack access to personal healthcare providers, the data suggest that healthcare delivery systems may have lacked capacity to equitably distribute vaccines beyond their traditional markets.
The data also show that initial targets for vaccination coverage did not achieve population immunity, as anticipated. This was due, in part, to the emergence of more transmissible variants of the virus, which occurred concurrently with declining adherence to public health guidance aimed at slowing disease transmission. Thus, multiple surges in cases associated with the Alpha (November 2020 to February 2021), Delta (August 2021 to October 2021), and Omicron (November 2021 to March 2022) variants were able to evade the population immunity conferred by vaccination efforts. These surges led to recurring spikes in cases, hospitalizations, and deaths throughout 2021.
Key data findings follow:
• In 2021, more than 70% of adults had received at least one COVID-19 vaccine, and more than half of adults (56.6%) completed a two-dose “primary series” vaccination.
• Vaccine use also varied within the population. Older adults, NH-Asian people, and people living in metropolitan areas were more likely to complete the primary COVID-19 vaccine series than other groups.
• Although a federal mandate covered the cost of COVID-19 vaccines and prohibited prior authorization or cost sharing to get the vaccine, uninsured, publicly insured, and low- income people were less likely to complete the COVID-19 primary series. The data signal that factors other than vaccine costs hindered vaccination efforts.
• Most Americans trust their healthcare professional for information about the COVID-19 vaccine. But the percentage of Americans who received a recommendation to get the COVID-19 vaccine from their healthcare professional was lower than 40% in 2021, and rates were similar among all racial and ethnic groups.
• Uninsured people and people with annual incomes lower than $75,000 were less likely to be recommended for COVID-19 vaccination by a healthcare professional. This was probably because these populations had less access to healthcare professionals, not because healthcare professionals treated them differently.
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2023 National Healthcare Quality and Disparities Report 7
• Healthcare professionals were especially vulnerable to SARS-CoV-2 infection and its consequences. Thus, they were prioritized to receive the COVID-19 vaccine early. Healthcare workers were more likely to complete the two-dose COVID-19 vaccination series than other adults in 2021. But healthcare workers in nonmetropolitan areas and in publicly insured, uninsured, low-income, and high social vulnerability groups were less likely to get the vaccine than their colleagues in other groups, mirroring disparities seen in the overall adult population. These findings provide further evidence that financial and structural access barriers hindered health systems’ ability to equitably distribute vaccines.
• Most COVID-19 deaths occurred among adults age 65 and over. But large numbers of deaths also occurred among adults ages 50-64 and 18-49, especially during surges associated with the Alpha, Delta, and Omicron variants. During the second year of the pandemic, adults age 65 and over were less likely to get infected but substantially more likely to die if infected.
• Among racial and ethnic groups, NH-AI/AN, NH-Native Hawaiian/Pacific Islander (NHPI), Hispanic, and NH-Black populations were more likely to die from COVID-19 than other groups. NH-NHPI people were less likely to get infected but more likely to die if infected. Hispanic and NH-Black people were more likely to get infected but exhibited similar risks of dying if infected as NH-White people. NH-AI/AN individuals were both more likely to get infected and more likely to die if infected.
• The varying patterns among different racial and ethnic groups suggest that different underlying factors caused each group’s higher COVID-19 death rates. They signal the possibility that achieving equitable health outcomes may require tailored disease mitigation strategies to address different groups’ specific concerns.
• Disparities in COVID-19 deaths also occurred between metropolitan and nonmetropolitan communities. People in nonmetropolitan communities appeared to be somewhat more likely to get infected and appeared to be at higher risk of dying if infected. Limited access to hospital and critical care services may have contributed to the higher COVID-19 death rates experienced in those communities. Lower uptake of the COVID-19 vaccine in small towns and rural areas may also have contributed to these outcomes.
Impact of COVID-19 on Hospitals This topic examines the healthcare delivery sector that provides acute care services to people with serious, sometimes critical, injuries and illnesses. Hospitals were a vital resource during the COVID-19 PHE. Thus, the nation had strong interest in ensuring that they had sufficient capacity to meet demand for acute and critical care services, particularly during the initial surge of cases in early 2020 and subsequent surges associated with the Alpha, Delta, and Omicron variants.
Key findings follow:
• Hospital and emergency department (ED) capacity was closely coupled with COVID-19 cases. Data show increased ED visits and hospital admissions during the spike in cases associated with the Alpha, Delta, and Omicron variants that occurred throughout 2021. Data also show decreased ED visits and hospital admissions for non-COVID-19 conditions during surge periods, suggesting that non-COVID-19 conditions were crowded out by COVID-19 cases.
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8 2023 National Healthcare Quality and Disparities Report
• Admissions for COVID-19 often required critical care services. Among middle-age and older adults hospitalized for COVID-19 between March 2020 and March 2022, the median weekly percentage who required ventilator support was more than 10%. At times, use of ventilators rose as high as 26.6% for adults ages 30-59 and 28.2% for adults age 60 and over. For context, approximately 5.3% of people hospitalized for severe community- acquired pneumonia required mechanical ventilation.
• Adults admitted for COVID-19 age 60 and over were more likely to die in the hospital than adults ages 30-59, but death rates in both groups were high. For example, in the first week of July 2022, during the surge associated with the Omicron variant, 17.5% of adults age 60 and over admitted for COVID-19 died, and 11.9% of adults ages 30-59 died.
• People hospitalized with COVID-19 often required prolonged treatment, especially if they needed ventilator support. The weekly average hospital length of stay (LOS) ranged between 6.8 and 14.7 days for adults with COVID-19 age 60 and over and 5.1 and 34.5 days for adults ages 30-59.
• One outcome of people with COVID-19 needing prolonged care was that flow through the hospital slowed, resulting in delays admitting people from the ED and overall delays in assessing and treating people from the ED. The overall average hospital LOS increased by 4.3%, from 4.7 days in 2019 to 4.9 days in 2020.
• Median ED wait times (the total time spent in the ED) increased from 141 to 151 minutes (a 7.1% increase) between 2019 and 2020-2021. Median ED boarding times (the time between decision to admit and moving into a hospital bed) increased from 100 to 126 minutes (a 26.0% increase) between 2019 and 2020-2021.
• The stress put on hospitals by the COVID-19 PHE affected people hospitalized with COVID-19 more than patients hospitalized for non-COVID-19 conditions. Patient safety measures that did not include COVID-19 patients had been improving over the past 5 years.
■ From 2016 to 2020, rates of sepsis after surgery decreased from 5.1 to 3.8 infections per 1,000 admissions.
■ Rates of central line-associated bloodstream infections decreased from 0.13 to 0.09 infection per 1,000 admissions.
■ Rates of hospital-associated pulmonary embolism or deep vein thrombosis (blood clots) decreased from 3.8 to 3.0 cases per 1,000 admissions.
Impact of COVID-19 on Ambulatory Care This topic examines preventive care services, which are typically delivered in primary care settings. Early experiences during the COVID-19 PHE raised concern that financially distressed primary care practices would close, limiting access to preventive care services. Reports that many people were deferring routine medical visits also raised concern that fewer people would receive primary care services, leading to a wave of preventable disease later. Two exemplars of preventive services provided in primary care settings are chronic diabetes management and screening for cancer. Measures related to these conditions suggest that COVID-19 had a limited impact on quality of preventive care.
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2023 National Healthcare Quality and Disparities Report 9
Key findings follow:
• Approximately 1 in 6 adults delayed getting medical care due to COVID-19 in 2020. Adults age 65 and over were more likely to defer medical visits than adults ages 18-44 (22.0% vs. 12.8%), as were people with any disability compared with people with no disability (25.2% vs. 15.0%). Hispanic people were less likely to defer medical care than other racial and ethnic groups. People in micropolitan (small town) areas were less likely to defer care compared with other communities.
• Diabetes management: ■ For preventive diabetes care, the percentage of people with diabetes who received
influenza vaccination increased in 2020. There were, however, no statistically significant changes in the percentage of people who received recommended diabetes monitoring or dilated eye examination. The percentage of people with diabetes who received a foot examination decreased (worsened), continuing a multiyear trend.
■ Disparities in delivering preventive diabetes care were observed. In 2020, Hispanic adults age 40 and over with diabetes were less likely to have at least two hemoglobin A1c measurements, have their feet checked for sores or irritation, or receive a flu vaccination compared with NH-White adults. Although the differences among these groups fell short of statistical significance in 2019, similar patterns were observed.
■ Although minor differences in preventive care services were observed among people living in different locations of residence, overall trends for preventive care delivery between 2002 and 2019 show an absence of urban/rural disparities for hemoglobin A1c monitoring, dilated eye exams, and diabetic foot exams.
• Cancer screening: ■ Nationally, there were no statistically significant differences in screening rates for
breast and cervical cancer between 2019 and 2021. Year-to-year colorectal cancer screening was not assessed due to recent changes in how these data are collected.
■ Cancer screening appeared to decrease among some racial and ethnic groups:
Rates of breast cancer screening with mammogram decreased between 2019 and 2021 for Hispanic (78.2% to 73.8%), NH-Asian (72.4% to 66.3%), and NH- multiracial people (73.7% to 64.2%), while rates increased slightly for NH-White people (75.9% to 76.%). None of the changes were statistically significant.
Rates of cervical cancer screening with a Pap smear or human papillomavirus test decreased between 2019 and 2021 for Hispanic (70.4% to 69.1%), NH-Asian (67.8% to 63.9%), NH-Black (78.1% to 74.4%), and NH-multiracial people (80.2% to 77.2%) and remained unchanged for NH-White people (79.9% in both years). These changes were not statistically significant.
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■ Among urban and rural groups, overall, people in metropolitan communities were more likely to receive cancer screening than those in nonmetropolitan ones. This disparity appeared to narrow, as cancer screening rates decreased among people in cities and increased among people in rural counties:
Between 2019 and 2021, breast cancer screening rates decreased from 77.3% to 75.5% for people in large central metropolitan areas and from 78.5% to 77.3% for large fringe metropolitan areas. At the same time, it increased from 67.6% to 71.9% for people in noncore counties. These changes were not statistically significant.
Between 2019 and 2021, cervical cancer screening rates decreased by 4.9% for people in large central metropolitan areas (77.5% to 73.7%) but increased by 10.6% for people in noncore counties (66.8% to 73.9%). These changes met criteria for statistical significance.
Impact of COVID-19 on Nursing Homes This topic examines the healthcare delivery sector that provides long-term and residential support for older adults and other people with disabilities that prevent independent living. Some services also furnish short-term postacute care to safely transition people from the hospital to home. During the COVID-19 PHE, nursing homes, as one example, were an epicenter of disease activity due to factors that included close living conditions, physically vulnerable residents, and limited access to personal protective equipment.
Key findings follow:
• Case rates among nursing home residents correlated with case rates among nursing home workers, indicating infections transmitted bidirectionally between workers and residents. But COVID-19 deaths among nursing home residents far exceeded deaths among workers, emphasizing the heightened risks experienced by nursing home residents who were mostly older, medically vulnerable, and at higher risk than the mostly younger workforce who cared for them.
• COVID-19 vaccination rates among nursing home residents and workers increased gradually over the first year of vaccine availability and approached 90% as of 2022. Six months after vaccines became available, almost 80% of nursing home residents had received the primary COVID-19 vaccine series, and almost 60% of nursing home workers had. By February 2022, the percentage of primary series vaccine completion exceeded 85% in both groups.
• The nursing home workforce largely consists of low-wage personnel with limited training and high rates of turnover. Workforce capacity had been shrinking before the COVID-19 PHE, and COVID-19 exacerbated this issue. COVID-19 infections required that nursing home workers isolate several days to weeks to avoid infecting residents, which led to understaffing and conditions that promoted worker burnout.
• More than 80% of nursing home workers are women. Between 2019 and 2022, the number of female nursing home workers decreased 12%, and the number of male workers decreased 7%.
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• Between May 2020 and January 2023, the percentage of nursing homes reporting “critical” shortages of nursing staff ranged between 14% and 27%. The percentage reporting a critical shortage of aides ranged between 16% and 29%. The percentage reporting a critical shortage of clinical staff, such as physicians, physician assistants, and advanced practice nurses, ranged between 2% and 4%.
• Worsening shortages coincided with surges associated with the Alpha, Delta, and Omicron variants. More than one in four (28%) nursing facilities nationally reported staffing shortages as of March 2022, when the Omicron-associated surge was receding. The greatest shortages were in Alaska (63%), the lowest in California (3%).
• Interventions to limit disease transmission, such as isolation or reduced mobility, and shortages of nursing home workers may have negatively affected quality of care for nursing home residents. The overall pattern of nursing home quality measures suggests that long-stay nursing home residents may have had less access to staff assistance and less mobility.
• The Centers for Medicare & Medicaid Services temporarily exempted nursing home providers from submitting Minimum Data Set assessment data, so apparent trends should be interpreted with caution. But available data indicate that long-stay nursing home residents who reported needing help with daily activities was 23.7% in 2020, up from 19.9% in 2019.
• Long-stay nursing home residents who had moderate to severe pain was 7.6% in 2020, up from 7.0% in 2019. Long-stay nursing home residents who reported worsening ability to move independently was 30.3% in 2020, up from 23.2% in 2019.
• In contrast, measures that assess the effects of limiting interventions on residents or limiting their mobility were essentially unchanged. Rates of long-stay nursing home residents with urinary tract infections were 1.8% in 2019 and 1.9% in 2020; and rates of long-stay nursing home residents who experienced a serious fall were 0.6% in 2019 and 0.55% in 2020.
Impact of COVID-19 on Telehealthcare This topic examines the delivery of healthcare services through telecommunication technologies. Policy changes implemented during COVID-19 enabled more telehealthcare service use to minimize in-person contact and decrease disease transmission. The term “telehealthcare” includes many different types of services, including audio-only encounters that resemble telephone consultations, and video-plus-audio encounters. NHQDR data indicate that the type of service and overall telehealthcare use varied across populations. Telehealthcare use rates were often lower in populations with the potential to benefit the most from virtual care.
Key findings follow:
• Telehealthcare use has increased, especially for behavioral health specialties (such as psychology and psychiatry) and primary care. Telehealthcare accounted for about 1% of behavioral health specialty visits and non-behavioral health primary care visits in January 2020. But rates increased during the COVID-19 pandemic such that more than 55% of behavioral health specialty visits and approximately 23% of non-behavioral health primary care visits were telehealthcare visits in April 2020.
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• Although telehealthcare use waned as COVID-19 receded, it still accounted for approximately 35% of behavioral health specialty visits and 5% of non-behavioral health primary care visits in December 2021.
• Overall, 8.8% of all physician’s office visits in 2021 were telehealthcare visits. Use varied by medical practice type and by population characteristics. Rates were higher for practices that provided services that do not require in-person contact, such as ordering and interpreting diagnostic studies, prescribing medications, and counseling patients. Rarely, practices that require physical contact to examine or treat people, such as ophthalmology, provided telehealthcare services.
• In 2021, telehealthcare use rates were lowest for people age 65 years and over (3.1% vs. 15.8% for people ages 18-44 years) and people living in noncore areas and small metropolitan areas (3.7% and 4.8%, respectively, vs. 11.7% in large central metropolitan areas).
• In 2021, more practices provided audio-only services (67.0%) than video-plus-audio services (56.4%).
• In 2021, older patients and low-income people were less likely to have audio-plus-video visits: 42.2% of people age 65 and over vs. 71.7% of adults ages 18-44 years; and 50.1% of people with family incomes less than 100% of the poverty guideline vs. 71.5% of people with family incomes 400% or more of the poverty guideline.
• Telehealthcare poses identifiable barriers to healthcare delivery. In 2021, of practices that use telehealthcare technology, 70.4% of physicians reported patients’ difficulty using technology as a factor affecting use of telehealthcare and 64.3% reported limitations in patients’ access to technology as a factor.
• While healthcare providers perceived telehealthcare as a useful resource, they indicated the need for telehealthcare quality improvement. In 2021, 62.0% of practices that used telehealthcare technology were very or somewhat satisfied with using telehealthcare technology for patient visits and 70.8% planned to continue using telehealthcare visits when appropriate after the COVID-19 pandemic ended. However, only 31.0% of practices that used telehealthcare technology described being able to provide similar quality of care during telehealthcare visits as during in-person visits.
Quality and Disparities Tables: Key Findings Readers will find the full collection of 555 NHQDR measures online at https://datatools.ahrq.gov/nhqdr and in the Healthcare Quality and Disparity tables in Appendix B of the report. The tables summarize each measure, and each table shows (1) key details about the measure; (2) the nation’s overall performance (quality) on the measure; and (3) difference in performance for priority populations or subgroups (disparities).
Readers will discover many healthcare delivery trends in the tables. Five notable findings follow.
Cost of Care – More Americans report higher burden of healthcare costs, particularly those with private health insurance:
• The overall percentage of people under age 65 whose family health insurance premium and out-of-pocket health expenditures consumed more than 10% of total family income rose 8.9% (from 14.3% to 15.7%) between 2002 and 2020.
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2023 National Healthcare Quality and Disparities Report 13
• The percentage of people with private, employer-sponsored health insurance reporting that premiums plus out-of-pocket costs consumed more than 10% of family income rose by 25.9% (from 12.3% to 16.6%) between 2002 and 2020.
• For comparison, the percentage of people with publicly sponsored health insurance reporting that premiums plus out-of-pocket costs consumed more than 10% of family income decreased by 35.1% (from 17.7% to 13.1%) between 2002 and 2020.
Postoperative Sepsis – Efforts to improve patient safety by avoiding healthcare-associated infections have yielded measurable improvements in hospital and other healthcare settings:
• Rates of sepsis after surgery decreased 31.9% (decreasing from 5.1 to 3.8 infections per 1,000 elective surgery admissions) between 2016 and 2020.
• Similarly, hospital admissions with central venous catheter-related bloodstream infections—a common underlying cause of sepsis—decreased 44.4% (from 0.13 to 0.09 infections per 1,000 hospital discharges) between 2016 and 2020.
Adolescent Mental Health – Adolescents’ need for mental health services has grown but access to treatment remains limited, particularly among low-income and Hispanic youths.
• Emergency department visits for mental health diagnosis by children and adolescents ages 0-17 years increased 11.5% (from 784.1 to 886.4 visits per 100,000 population) between 2016 and 2020.
• Death due to suicide among adolescents ages 12-17 increased by 75.7% (rising from 3.7 to 6.5 deaths per 100,000 population) between 2008 and 2021.
• Only 40.6% of adolescents ages 12-17 with a major depressive episode received treatment for depression in 2021.
■ Access to treatment was far lower for adolescents with household incomes below the poverty guideline (35.8%) than for adolescents with household incomes 400% of the poverty guideline or higher (46.4%).
■ Access to treatment was also far lower for Hispanic (30.2%) youths than for NH- White (47.4%) youths.
Opioid Use Disorder – Opioids fall into three broad categories: “natural opioids” are extracted from the seed pods of certain varieties of poppy plants; “semisynthetic opioids” are compounds derived from natural opiates; and “synthetic opioids” are compounds manufactured from chemical raw materials that act on the same receptors as natural opioids. Natural opioids include medications such as oxycodone, hydrocodone, oxymorphone, and hydromorphone. Synthetic opioids include medications such as fentanyl and tramadol, as well as legally and illegally manufactured substances.
Mortality data indicate that overprescribing and diversion of prescription opioid analgesics initiated the early waves of the opioid overdose epidemic. But deaths due to illicit “synthetic” opioids, which are manufactured and distributed outside healthcare delivery systems, drive the current wave. Other data also show that health systems’ efforts to limit prescribing of natural and semisynthetic opioid analgesics have had modest effects on the opioid overdose epidemic because much of the recent rise in opioid-related mortality is attributable to synthetic opioids.
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14 2023 National Healthcare Quality and Disparities Report
The data indicate greater need for health systems to prescribe medication for opioid use disorder (MOUD, which includes treatment with methadone, buprenorphine, or naltrexone). These are evidence-based treatments that reduce opioid use and risk for overdose.
• The national percentage of adults who filled four or more outpatient opioid prescriptions in the calendar year decreased between 2013 and 2020 (from 4.6% to 2.6%).
• Between 2011 and 2021, the rate of drug overdose deaths due to natural or semisynthetic opioids fluctuated between 3.5 and 4.4 deaths per 100,000 population, while rates of drug overdose due to synthetic opioids increased sharply from 0.9 to 21.8 deaths per 100,000 population (an over 2,000% increase).
• Only 22.1% of people with an opioid use disorder received MOUD in 2021
Kidney Transplantation – Chronic kidney disease affects approximately 14% of adults, and approximately 0.2% have end stage kidney disease that requires long-term dialysis or kidney transplantation. Although dialysis can be lifesaving, kidney transplantation is preferred because it often provides people with better quality of life, reduced treatment burden, and longer life expectancy. Yet relatively few Americans have access to this option:
• The national percentage of people who were registered on a waiting list or received a kidney transplant within a year of starting dialysis did not change between 2000 and 2019 (15.2% to 15.7%).
• Although racial and ethnic disparities for this measure narrowed between 2000 and 2019, the percentage of Hispanic (12.9% to 14.1%) and NH-Black (11.2% to 13.1%) people who were registered on a waiting list or received a kidney transplant within a year of starting dialysis remained lower than for NH-White people (18.0% to 17.1%).
Resources To Improve Healthcare HHS and the administration have produced and distributed a range of resources to support healthcare delivery systems and aid Americans in addressing the concerns outlined in this report. For resources relevant to each Special Emphasis Topic, the NHQDR links to HHS websites relevant to the topic. The NHQDR team invites readers to use the data and resources in this report to improve quality of care and advance health equity. They also invite readers’ suggestions for ways to improve how they monitor healthcare quality and disparities in our nation.
Publication No. 23(24)-0091-EF December 2023 www.ahrq.gov
e
- Acknowledgments
- Contents
- Executive Summary
- Portrait of American Healthcare: Key Findings
- Demographics
- Leading Health Concerns
- Social Determinants of Health
- Healthcare Delivery Systems
- National Health Expenditures
- Geographic Variations in Care
- Special Emphasis Topics: Key Findings
- Impact of COVID-19 on the U.S. Population
- Impact of COVID-19 on Hospitals
- Impact of COVID-19 on Ambulatory Care
- Impact of COVID-19 on Nursing Homes
- Impact of COVID-19 on Telehealthcare
- Quality and Disparities Tables: Key Findings
- Resources To Improve Healthcare
- Portrait of American Healthcare
- Demographics
- Leading Health Concerns
- Social Determinants of Health
- Healthcare Delivery Systems
- Ambulatory Medical and Surgical Offices
- Emergency Departments
- Hospitals
- Hospitals Serving Communities That Experience Higher Risk for Poor Health Outcomes
- Hospital Bed Capacity
- Postacute and Long-Term Care
- Summary
- National Healthcare Expenditures
- Geographic Variations in Care
- References
- Overview of NHQDR Special Emphasis Topics
- Biologic and Clinical Features of COVID-19
- COVID-19 vs. Influenza
- Post-COVID-19 Conditions
- COVID-19 Variants of Concern
- National Response to the COVID-19 Public Health Emergency
- Mitigating SARS-CoV-2 Transmission
- Accelerating Development of COVID-19 Tests, Treatments, and Vaccines
- Expanding Health Insurance Coverage To Respond to COVID-19
- Expanding Healthcare System Capacity To Respond to COVID-19
- Mitigating Socioeconomic Impact of COVID-19
- Tracking COVID-19: National Measures of COVID-19 Activity
- NHQDR Special Emphasis Topics
- References
- Impact of COVID-19 on Population Health, 2020-2022
- Factors Contributing to COVID-19 Mortality
- COVID-19 Vaccine Use
- Healthcare Delivery of COVID-19 Vaccines
- Healthcare Worker Use of COVID-19 Vaccines
- Disparities in COVID-19 Outcomes
- Age Disparities
- Racial and Ethnic Disparities
- Urban-Rural Disparities
- Discussion and Conclusions
- Resources
- References
- Impact of COVID-19 on Hospital Care
- Inpatient and Emergency Department Visits With Confirmed COVID-19
- Patient Experience With Hospital Care
- Emergency Department Wait Times
- COVID-19 and Patient Safety
- Discussion and Conclusions
- Resources
- References
- Impact of COVID-19 on Ambulatory Care
- Delayed Care Due to COVID-19
- Impact of COVID-19 on Diabetes Care
- Impact of COVID-19 on Cancer Screening
- Discussion and Conclusions
- Resources
- References
- Impact of COVID-19 on Nursing Homes
- COVID-19 Cases and Deaths in Nursing Homes
- Vaccines in Nursing Homes During the COVID-19 Pandemic
- Staff Shortages During the COVID-19 Pandemic
- Impact of Nursing Home Staff Shortages on Quality
- Findings
- Discussion and Conclusions
- Resources
- References
- Growth of Telehealthcare During the COVID-19 Pandemic
- Background
- Telehealthcare Service Use Before the COVID-19 Pandemic Was Limited
- Findings
- Telehealthcare Service Use Increased During the COVID-19 Pandemic
- Use of Telehealthcare Services Varied by Provider and Patient Characteristics
- Mode of Telehealthcare Use Varied by Patient Characteristics
- Barriers to Telehealthcare Use Are Common
- Findings on Perception of Care Provided via Telehealthcare Are Mixed
- Discussion and Conclusions
- Resources
- References
- Blank Page
**Write FOUR 100-200 word replies to the Four (4) individual discussion responses ** There should be 4 different posts. Each post is numbered and has a name.
APA 7 format.11 pt. Calibri font., with proper in-text citations. Please provide a copy of all references, A.I., and plagiarism reports.
The primary post(s) are provided as an attached file.
Assignment Details:
To help you with your discussion, please consider the following questions:
What clarification do you need regarding the posting?
What differences or similarities do you see between your posting and other classmates' postings?
What additional questions do you have after reading the posting?
What item you found to be compelling and enlightening.
PART 1
1. Initial Question: Over the past 3 weeks, you have been working on components of the Key Assignment. To this point, you have chosen your disease or health condition and have written a status report using the epidemiology triad to describe the disease. Your Key Assignment is due next week. This week, you will work on an outline for your final assignment to-date and post it to the Discussion Board.
Respond to at least 2 of your fellow classmates with at least a 100–200-word reply about their Primary Task Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following questions:
· What did you learn from your classmate's posting?
· What additional questions do you have after reading the posting?
· What clarification do you need regarding the posting?
1. Student Post to Respond to: Ariyan Berotte
Diabetes
· I. Abstract
· a. Overview about diabetes
· b. Purpose of the intervention
· c. Key points
· II. Introduction
· a. Definition of diabetes
· i. Different types
· 1. Type 1
· 2. Type 2
· 3. Gestational
· b. Life with living with diabetes
· i. Changing different factors
· 1. Lifestyle
· 2. Eating
· 3. Smoking
· 4. Drinking
· 5. Physical activity
· ii. Steps taken to control diabetes
· 1. Insulin injections
· 2. Monitoring glucose numbers
· 3. Changing eating habits
· III. History of diabetes
· a. When diabetes started and what factors started it
· b. Rates of diabetes
· c. Risks that come with having diabetes
· IV. Demographics
· a. Age
· b. Race
· c. Ethnicity
· d. Gender
· e. Population
· V. Social factors
· a. Financial status
· i. Low-income vs wealthy
· b. Lifestyle
i. Little to no physical activity
· ii. Drinking
· iii. Smoking
· iv. Bad eating habits
· c. Race
· i. African American
· ii. White American
· iii. Hispanic
· iv. Mixed races
· d. Living conditions
· i. Low income
· ii. Pollution within the air and water
· iii. Environment
· e. Education
· i. Knowledge about diabetes
· ii. The causes
· iii. Ways to treat diabetes
· VI. Morbidity Rates and Mortality Data
· a. Rates due to diabetes
· b. Years that the rates were higher
· c. Comparison of rates between different states
· d. Trends of the rates
· e. Survival rates
· VII. Incidence and Prevalence Data
· a. Rates due to diabetes
· b. Trends of the years
· c. How different races are affected
· VIII. Description for Intervention
· a. Introduction to the plan
· b. Who the plan is intended for
· c. Who will be leading the intervention
· d. What kind of classes will be available
· e. What needs to be done to reserve the class
· IX. Cost analysis
· a. Cost of implementing the intervention
· b. Description of how the money will be used
· c. Where the money will come from
· d. Who will be receiving the money
· X. Justification for Intervention
· a. The point of the intervention
· b. How the intervention will help
· c. Goals for the intervention
· d. Steps taken during the intervention
· XI. Conclusion
· a. Summary about diabetes
· b. Recommendations
2. Student Post to Respond to: brian michael
Proposal to Reduce the Incidence and Prevalence of Diabetes Mellitus in Los Angeles
Introduction
Diabetes Mellitus, particularly Type 2 diabetes, has become a significant public health concern in Los Angeles. The growing prevalence of this chronic disease places a significant strain on both the healthcare system and the broader community. As the Program Manager, it is essential to outline a comprehensive strategy to mitigate the incidence and prevalence of diabetes, focusing on the most vulnerable populations.
History of the Disease
Diabetes Mellitus has seen a rising trend globally, and Los Angeles is no exception. Over the past two decades, the prevalence of diabetes in Los Angeles County has surged, closely linked to increasing obesity rates and an aging population. “In 2018, approximately 10.5% of adults in Los Angeles County were diagnosed with diabetes, a sharp increase from previous years.” (Los Angeles County Department of Public Health, 2018). This trend highlights the urgent need for targeted interventions.
Needs Assessment for the Population
1. Demographics
· Los Angeles ranks among the most ethnically diverse cities in the United States, with large populations of Hispanic, African American, and Asian residents. The demographic distribution is crucial in understanding the risk factors associated with diabetes. Hispanic and African American communities, in particular, have higher rates of diabetes compared to other racial groups.
2. Social Factors
· Several social determinants of health significantly increase the risk of diabetes in Los Angeles. These include poverty, limited access to healthcare, and low levels of health insurance coverage. “Residents in lower-income neighborhoods face barriers to accessing nutritious food and engaging in physical activity, contributing to higher obesity rates and, consequently, higher diabetes prevalence.” (California Health Interview Survey, 2019)
3. Morbidity and Mortality Data
· Diabetes is a leading cause of morbidity and mortality in Los Angeles. Complications from diabetes, such as cardiovascular disease, kidney failure, and lower-extremity amputations account for a substantial portion of healthcare costs in the county. The mortality rate from diabetes-related complications is disproportionately higher among Hispanic and African American populations.
4. Incidence and Prevalence Data
· The incidence of diabetes in Los Angeles continues to rise, with new cases being diagnosed annually. “As of the latest data, the prevalence of diabetes in Los Angeles County is around 12%, with certain neighborhoods experiencing rates as high as 15%.” (Los Angeles County Department of Public Health, 2020). The growing number of prediabetes cases further emphasizes the need for early intervention.
Suggested Intervention Program with Cost Analysis
To address the growing burden of diabetes in Los Angeles, I propose implementing a community-based intervention program that includes the following components:
Diabetes Prevention and Education Workshops:
· These workshops will focus on educating high-risk populations about healthy eating, physical activity, and diabetes management. Partnering with local community centers and schools, the program will offer free classes and resources. Estimated cost: $500,000 annually.
Mobile Health Clinics:
· Deploying mobile health clinics in underserved neighborhoods will provide screenings, preventive care, and follow-up services. This will help bridge the gap in healthcare access for low-income residents. Estimated cost: $1.2 million annually.
Discounted Access to Healthy Foods:
· Collaborating with local farmers’ markets and grocery stores to provide discounts on fresh produce for low-income families. Estimated cost: $800,000 annually.
Justification and Explanation
The proposed intervention focuses on the populations in Los Angeles that are most at risk, particularly Hispanic and African American communities. By focusing on prevention, education, and improved access to healthcare and nutritious foods, this program is designed to lower the incidence of diabetes and lessen its impact on the community. The investment in mobile health clinics and subsidized food access addresses the social determinants of health, making this a comprehensive and cost-effective approach.
Conclusion
This proposal outlines a strategic plan to combat the growing diabetes epidemic in Los Angeles. By implementing these targeted interventions,we can lower the incidence and prevalence of diabetes, improve health outcomes for vulnerable populations, and alleviate the economic burden on the healthcare system.
PART 2
1 . Initial Question: Respond to at least 2 of your fellow classmates with at least a 100-word reply about his or her Primary Task Response regarding items you found to be compelling and enlightening. To help you with your discussion, please consider the following questions:
2. What did you learn from your classmate's posting?
3. What additional questions do you have after reading the posting?
4. What clarification do you need regarding the posting?
5. What differences or similarities do you see between your posting and other classmates' postings?
1. Student Post to Respond to: Ashtyn Weaver
One of the most compelling topics learned in the Managing the Health of Populations class is the role of social determinants of health in shaping the well-being of individuals and communities. This topic emphasizes that health outcomes are not solely determined by individual choices or access to healthcare but are deeply influenced by broader social, economic, and environmental factors. Understanding these determinants is crucial for designing effective public health interventions that address the root causes of health disparities and promote health equity. Through discussions with peers, students can explore the complexities of social determinants of health and their impact on population health outcomes. By sharing different perspectives and experiences, students can gain a more nuanced understanding of how these factors interact and contribute to health inequalities.
Engaging in discussions with peers is an essential aspect of learning, as it allows students to exchange ideas, challenge their own assumptions, and deepen their understanding of the subject matter. Students can also learn how to critically evaluate research studies, assess the quality of evidence, and apply research findings to real-world public health problems. Participating in discussions allows students to practice these skills, receive feedback from peers and instructors, and deepen their understanding of how evidence-based practice can inform decision-making in public health. There may still be areas of the course material that remain unclear or require further clarification. By incorporating more case studies, simulations, or guest speakers from the field, students can gain a more comprehensive understanding of how public health principles are applied in practice. These approaches can provide students with valuable insights into the complexities of managing the health of populations and equip them with the skills needed to address emerging public health challenges effectively
2. Student Post to Respond to: natalie carroll
In this course, the most compelling topics revolved around managing the health of populations, with a focus on heart disease in Tennessee for the key assignment. Learning about the risk factors for heart disease, such as physical inactivity, tobacco use, and poor diet, was particularly enlightening. Understanding how these factors contribute to the prevalence of heart disease in Tennessee provided a solid foundation for exploring strategies to reduce the burden of the disease at a population level. Participating in discussions greatly deepened my understanding of the subject matter. Engaging with peers allowed me to hear different perspectives, which helped clarify complex concepts, such as how social determinants of health influence disease prevalence. Discussions around preventive strategies, like promoting healthier lifestyles and improving access to care, highlighted the importance of community-based interventions. These conversations reinforced my understanding of how public health initiatives can be tailored to address specific regional needs, such as the high rates of heart disease in Tennessee.
However, some areas could benefit from further clarification. For example, while the course covered various intervention strategies, I am still curious about the most effective ways to measure the long-term success of these programs. Understanding the metrics and evaluation methods for public health interventions would provide more insight into their sustainability and impact.
