This is the second national report by the U.S. Department of Health and Human Services on health care quality in America. This report extends the baseline established in the 2003 National Healthcare Quality Report for a set of health care quality measures across four dimensions of quality—effectiveness, safety, timeliness, and patient centeredness—in order to track trends and progress in health care quality.
 
The 2004 report is based on detailed analyses of 179 measures. The following three themes emerge from these analyses:

• Quality is improving in many areas, but change takes time
• The gap between the best possible care and actual care remains large
• Further improvement in health care is possible

The report is organized into the following main volumes:

• National Healthcare Quality Report: main body of the report summarizing the findings across the report's quality of care framework
• Measure Specifications Appendix: provides information about how to generate measures highlighted in the report as well as those that were examined but not included in the text
• Data Tables Appendix: provides detailed tables for most measures highlighted in the report or examined but not included in the text

The 2004 report is organized as a chartbook into the following chapters:

• Key Themes and Highlights
• Introduction and Methods
• Effectiveness. Examines quality of care for nine clinical conditions or care settings:
  • Cancer
    • Trends in colorectal cancer mortality
    • Advanced stage detection rate
    • Screening for colorectal cancer
  • Diabetes
    • Receipt of recommended interventions for diabetes management
    • State variation in HbA1c testing
    • Hospital admissions for long-term diabetes complications
  • End-stage renal disease
    • Adequacy of hemodialysis
    • Use of arteriovenous fistulas for venous access
  • Heart disease
    • Awareness, treatment, and control of cholesterol
    • Administration of beta blockers to heart attack patients
    • Administration of angiotensin-converting enzyme inhibitors to heart failure patients
  • HIV/AIDS
    • HIV-infection deaths for 100,000 population
    • New AIDS cases per 100,000 population, age 13 and older
    • Receipt of highly active antiretroviral therapy, prophylaxis for Pneumocystis pneumonia, and prophylaxis for Mycobacterium avium complex.
  • Maternal and child health
    • Maternity care
    • Child preventive services to prevent overweight in children
    • Experiences of care for children with and without special health care needs 
  • Mental health
    • Appropriate antidepressant medication treatment
  • Respiratory diseases
    • Receipt of recommended interventions for pneumonia by the elderly
    • Hospital admissions for pediatric asthma 
  • Nursing home and home health care
    • Prevalence of pain among postacute and chronic care residents
    • Prevalence of physical restraints among chronic care residents
    • Presence of pressure ulcers among postacute and chronic care residents
    • Improvements in mobility in home health episodes
    • Acute care hospitalization of home health patients
• Patient Safety. Tracks the following safety measures:
  • Hospital-acquired nosocomial infections
  • Adverse events and postoperative complications of care
  • Inappropriate use of medications by the elderly
• Timeliness. Examines the following measures related to timeliness and accessibility of care:
  • Time to initiation of thrombolytic therapy for heart attack patients
  • Patient perceptions of timeliness of appointments for care
• Patient Centeredness. Tracks patient experiences with routine and emergency care:
  • Patients who report that their doctor explains things clearly
  • Patients who report that their doctor shows respect for what they have to say
• List of Measures