Health care seeks to diagnose, treat, and improve the physical and mental well-being of all Americans. Across the lifespan, health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with death and dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable.1 Unfortunately, Americans too often do not receive care that they need, or they receive care that causes harm. Care can also be delivered too late or without full consideration of a patient's preferences and values. Many times, our system of health care distributes services inefficiently and unevenly across populations. Each year 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, as mandated by the U.S. Congress. The information amassed for the National Healthcare Quality Report (NHQR) since its inception is a growing knowledge base that can be used to address three critically important questions: What is the status of health care quality in the United States? Where is health care quality improvement most needed? How is the quality of the health care delivered to Americans changing over time? The significance of tracking this sector's performance is evident from many vantage points. More than $2 trillion is spent each year on health care in the United States.2 Spending on health care is escalating relentlessly, threatening the financial security of families and businesses. Quality and value are increasingly considered in the decisions patients and payers make. To help patients choose doctors and hospitals prudently, tools have been produced that gather information about hospitals and rate health care providers. To motivate providers to deliver high-quality care, some purchasers reward superior performance. In addition, some refuse to pay for additional care needed to correct hospital-acquired conditions that could reasonably have been prevented through the application of evidence-based medicine. Monitoring the success of these efforts is crucial to help stakeholders refine quality improvement activities and to lead Americans toward the optimal health care they need and deserve. The NHQR is built on more than 200 measures categorized across four dimensions of quality: effectiveness, patient safety, timeliness, and patient centeredness. Guided by a subcommittee of AHRQ's National Advisory Council and an HHS Interagency Work Group, the NHQR focuses on a group of core report measures that represent the most important and scientifically credible measures of quality for the Nation. By focusing on core measures, the NHQR provides a readily understandable summary and explanation of the key results derived from available data. Three themes from the 2009 NHQR emphasize the need to accelerate progress if the Nation is to achieve higher quality health care in the near future: Health care quality needs to be improved, particularly for uninsured individuals, who are less likely to get recommended care; Some areas merit urgent attention, including patient safety and health care-associated infections (HAIs); Quality is improving, but the pace is slow, especially for preventive care and chronic disease management. We also summarize AHRQ and HHS efforts to accelerate the pace of improvement by: Improving measurement; Removing barriers to quality care; Empowering providers with health information technology (HIT) and training; Establishing and sustaining partnerships to lead change.