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

2. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on September 9, 2015). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding. Mortality rates have fallen steadily in the U.S. over the past 30 years Overall age-adjusted mortality rate per 100,000 population

3. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on June 25, 2014). Infant mortality in the United States has improved by about 12% from 2000 to 2011 Infant Mortality, per 1,000 live births 2000 – 2013

4. Peterson-Kaiser Health System Tracker Source: Commonwealth Fund, “State Scorecard 2014” For more information: http://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecardhttp://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard Deaths amenable to healthcare in the U.S. have been steadily declining Amenable mortality per 100,000 population, in years

5. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on November 6, 2014). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding. Potential Years of Life Lost have fallen about 37% since 1980 Overall age-specific potential years of life lost per 100,000 population

6. Peterson-Kaiser Health System Tracker Source: University of Washington Institute for Health Metrics and Evaluation. For more information see: http://www.healthdata.org/search-gbd-data?s=united%20stateshttp://www.healthdata.org/search-gbd-data?s=united%20states Disease burden has declined from 1990 - 2010 Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 1990, 1995, 2000, 2005, and 2010

7. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundations analysis of the Behavioral Risk Factor Surveillance System (BRFSS). *Indicates statistically significant difference between 1996 and 2013. The percentage of adults reporting poor general health has increased across males and females, whites and Hispanics Percentage of adults reporting that their general health was poor, by sex and race/ethnicity, 1996 and 2013

8. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundations analysis of the Behavioral Risk Factor Surveillance System (BRFSS). All differences are statistically significant. The percentage of adults reporting poor physical or mental health in the past month has worsened over time Percentage of adults reporting that health was not good or prevented usual activities at least one day in the past 30 days due to physical illness and injury, or stress, depression, and emotional problems, 1996 and 2013

9. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundations analysis of the Behavioral Risk Factor Surveillance System (BRFSS). All differences are statistically significant. The average number of self-reported healthy days per month has decreased slightly over time Mean number of days in the past 30 days that health was good

10. Peterson-Kaiser Health System Tracker Source: Commonwealth Fund, “State Scorecard 2014” For more information: http://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecardhttp://www.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard Screening and preventive care among adults 50 and older has remained fairly static Percentage of adults ages 50 and older who received recommended screening and preventive care, in years

11. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health Care Utilisation", OECD Health Statistics (database). (Accessed on June 9, 2015). The percent of children receiving recommended doses of vaccines has improved over time Percentage of children ages 12-23 months who received all recommended doses of vaccines for Diphtheria, Tetanus, Pertussis, Measles, and Hepatitis B, in years

12. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention. National Vital Statistics Reports. “National and State Patterns of Teen Births in the United States, 1940-2013”. For more information: http://www.cdc.gov/nchs/data/nvsr/nvsr63/NVSR63_04.pdfhttp://www.cdc.gov/nchs/data/nvsr/nvsr63/NVSR63_04.pdf The teen pregnancy rate has declined 56% from 1991- 2014 Birth rates per 1,000 women aged 15-19, in years

13. Peterson-Kaiser Health System Tracker Source: Centers for Disease Control and Prevention/National Center for Health Statistics. National Health Examination Survey and National Health and Nutrition Examination Survey. The prevalence of overweight adults in the U.S. is beginning to decline after increasing for some time Age-standardized prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over, in years

14. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services. Geographic Variation Public Use File For more information see: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/ Medicare hospital admissions for ambulatory care- sensitive conditions has decreased about 27% Hospital admissions among Medicare beneficiaries ages 65-74 for ambulatory care-sensitive conditions per 1,000 beneficiaries

15. Peterson-Kaiser Health System Tracker Source: Agency for Healthcare Research and Quality. “2013 National Healthcare Quality Report.” http://www.ahrq.gov/research/findings/nhqrdr/nhqr13/2013nhqr.pdf Patients receiving recommended care has improved slightly from 2005-2010 Average proportion of recommended care received across a panel of quality care measures, in years 2005 and 2010

16. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services. "Summary of HCAHPS Survey Results.” Hcahpsonline.org/HCAHPS_Executive_Insight. [01/2007 – 12/2013]. Accessed 2/27/2015. Staff response to hospitalized patients has improved Percentage of hospitalized patients who reported hospital staff always managed pain well, responded when needed help to get to bathroom or pressed call button and explained medicines and side effects, in years

17. Peterson-Kaiser Health System Tracker Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base More women are receiving biopsy at the time of mastectomy or lumpectomy Percentage of women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 2004-2011

18. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program More people are receiving evidence-based care for heart attack when they arrive at a hospital Percentage of hospital patients with heart attack given percutaneous coronary intervention within 90 minutes of arrival or fibrinolytic medication within 30 minutes of arrival, United States, 2005-2012

19. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program More patients hospitalized for heart failure are given evidence-based prescriptions at discharge Percentage of hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, United States, 2005-2012

20. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services. "Summary of HCAHPS Survey Results.” Hcahpsonline.org/HCAHPS_Executive_Insight. [01/2007 – 12/2013]. Accessed 2/27/2015. More hospitalized patients are receiving instructions for recovery at home Percentage of hospitalized patients given information about what to do during their recovery at home, in years

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

22. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services. Geographic Variation Public Use File For more information see: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/ Medicare 30-day hospital readmission rates have declined Percent of inpatient readmissions within 30 days of an acute hospital stay, among Medicare beneficiaries 65 and older, 2007 - 2013

23. Peterson-Kaiser Health System Tracker Source: Centers for Medicare & Medicaid Services. Medicare Hospital Quality Chartbook, September 2014. For more information see: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/Medicare- Hospital-Quality-Chartbook-2014.pdfhttp://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/Medicare- Hospital-Quality-Chartbook-2014.pdf Mortality rates within 30 days after hospital admission for AMI, stroke, and pneumonia have decreased Hospital-level risk-standardized mortality rates in the 30 days after hospital admission for acute myocardial infarction, stroke heart failure, and pneumonia, in years

24. Peterson-Kaiser Health System Tracker Source: Surveillance, Epidemiology, and End Results Program (SEER) http://seer.cancer.gov/archive/csr/1975_2008/browse_csr.php?sectionSEL=5&pageSEL=sect_05_table.08.html (Accessed on August 19, 2015). Notes: SEER 9 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta). Based on follow-up of patients into 2008. Five-year survival for certain cancers are increasing Percentage of age-adjusted five-year relative survival for breast, colorectal, and cervical cancer, all ages, in years 1990-1992 and 2001-2007

25. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on September 9, 2015). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding. The mortality rate for cancers has been declining Age-adjusted neoplasms mortality rate per 100,000 population

26. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on September 9, 2015). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding. Mortality rates for diseases of the circulatory system have fallen dramatically over the last 30 years Age-adjusted diseases of the circulatory system mortality rate per 100,000 population

27. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on September 9, 2015). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding. The mortality rate for respiratory diseases has fallen over the past 10 years Age-adjusted respiratory diseases mortality rate per 100,000 population

28. Peterson-Kaiser Health System Tracker Source: OECD (2013), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on September 9, 2015). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding. Mortality rates for endocrine, nutritional and metabolic diseases have fallen over the last 15 years Age-adjusted endocrine, nutritional and metabolic diseases mortality rate per 100,000 population