Since 2003, the Agency for Healthcare Research and Quality (AHRQ), together with its partners in the Department of Health and Human Services (HHS), has reported on progress and opportunities for improving health care quality. With this fifth annual National Healthcare Quality Report (NHQR), these reports will have provided more than 50,000 data points about health care quality in the United States. Has it made a difference? Have Federal and State governmental agencies, provider organizations, insurers, and employers made progress in improving health care quality and safety? While every previous release of the NHQR has attempted to summarize the direction in which health care quality is going, this fifth report tries to summarize the progress that has been made and the remaining challenges to improve health care quality in this Nation. The NHQR is built on 218 measures categorized across four dimensions of quality-effectiveness, patient safety, timeliness, and patient centeredness. This year's report focuses on the state of health care quality for a group of 41 core report measures that represent the most important and scientifically credible measures of quality for the Nation, as selected by the HHS Interagency Work Group. The distillation of 41 core measures for the 2007 report provides a more readily understandable summary and explanation of the key results derived from the data. While the measures selected for inclusion in the NHQR are derived from the most current scientific knowledge, this knowledge base is not evenly distributed across health care. The analysis in the following pages centers on measures for which data are available from the baseline year of 2000 or 2001 and the comparison year of 2004 or 2005. Three themes that emerge from the 2007 NHQR emphasize the need to accelerate progress in achieving high quality health care: Health care quality continues to improve, but the rate of improvement has slowed; Variation in quality of health care across the Nation is decreasing, but not for all measures; The safety of health care has improved since 2000, but more needs to be done.