E-Mail This Article to a Friend HEALTH CARE Putting numbers to the gaps in health care BY DAVID S. BERNSTEIN

A pair of reports issued by the US Department of Health and Human Services in December has received little attention, but it’s got health-care-quality experts jazzed. They believe that these reports — which are the first of their kind and will establish base lines to be updated annually — might help finally reconcile the gap between the health care that’s possible, and the health care that actually exists in the US.

"The National Healthcare Quality Report" and the "National Healthcare Disparities Report" attempt, in broad, national, systematic ways, to quantify the level of health care people receive. The quality report includes hundreds of measures that have been undertaken, including health services (such as the percentage of pregnant women who received prenatal health care in the first trimester), as well as health outcomes (such as the percentage of infants with very low birth weights). The disparities report looks closely at how these statistics break down by patients’ race, education, socioeconomic status, and other factors.

But they share a bottom line: American health-care professionals do not always pursue the best practices.

"Health care is not uniformly excellent," says Helen Burstin of HHS’s Agency for Healthcare Research and Quality, which produced the reports. "Tinkering around the edges isn’t going to do it. We need significant systemic change."

Despite the reports’ significance, the media have mostly ignored them; a spokesperson for the HHS says that only two articles based on the reports have appeared in mainstream publications. Part of the problem may be that the "key findings" are mild and vague, with conclusions like "There is still a lot to learn" and "Greater improvement is possible."

"We don’t feel that it tells the whole story," says Jonathan Small, spokesperson for the Institute for Healthcare Improvement, in Boston. "There’s a tone in these reports that paints it as not that bad, and we think it is bad. People are not as safe in hospitals as they need to be."

Burstin has heard that complaint, but says that the hundreds of data charts in the reports are what ultimately matter. "When you see that only 20 percent of diabetics are getting all the tests they need over the course of a year, no matter what you write about it, that’s just not good," Burstin says.

Some of the reports’ many findings:

• Only 23 percent of those with hypertension have it under control.

• One in five elderly Americans is prescribed inappropriate or potentially harmful medication.

• Adverse drug reactions occur in 6.7 percent of hospitalized patients, and are rising.

• More than 40 percent of serious, life-threatening, or fatal adverse drug reactions in ambulatory settings were preventable.

• Only 62 percent of smokers have been advised to quit by their doctors.

• Blacks with cancer are 30 percent more likely to die from it than whites.

• Poorer women are less likely to have had a Pap smear in the past three years.

• Black diabetics are twice as likely as whites to require a foot amputation due to foot ulcer or infection.

• AIDS is the leading cause of death among black women between the ages of 25 and 34.

• Blacks with HIV infection are 12 times more likely than whites to die from it.

• Infant mortality is more than twice as high for blacks than for whites.