More than a decade ago, landmark studies found that adults in the United States only received slightly more than half of the recommended healthcare services they should receive. “Since that time, efforts have been made at the local, regional, and national levels to improve the quality of healthcare,” explains David M. Levine, MD, MA. “Few studies have gauged if this is actually occurring throughout the U.S. Some reports have been optimistic that care is improving, while others suggest that the pace of improvement is slow.

For a study published in JAMA Internal Medicine, Dr. Levine and colleagues measured 46 indicators of the quality of outpatient care delivered to U.S. adults to determine whether improvement efforts have been successful. They specifically looked at recommended care, inappropriate care, and patient experience. By evaluating care quality performance, Dr. Levine says that this data may help policymakers, clinicians, and healthcare system leaders in their efforts to target key areas for attention and improvement. The analysis reviewed trends from 2002 to 2013 using quality measures constructed from the Medical Expenditure Panel Survey.

Key Trends

Results of the study showed that clinical quality composites improved marginally between 2002 and 2013 in the domains of recommended medical treatments, counseling and cancer screening as well as avoidance of inappropriate cancer screenings. “However, trends in avoidance of inappropriate medical treatments and inappropriate antibiotic use worsened during the study period,” says Dr. Levine. Three other clinical quality measures—including recommended diagnostic and preventive testing, recommended diabetes care, and inappropriate imaging avoidance—remained unchanged.

“Despite more than a decade of improvement efforts, the quality of outpatient care delivered to U.S. adults has not consistently improved,” says Dr. Levine. “Although there were some areas of improvement, several composites continue to be disappointingly low or relatively unchanged. These deficits in care pose serious hazards to the health of Americans.” He notes that such deficits represent missed care opportunities as well as waste and potential harm from overuse of treatments. Importantly, these trends are occurring as the American population is older and has accrued more health problems over the past decade.

The study also found that the proportion of U.S. adults who rated their healthcare experience highly improved in the domains overall care, physician communication, and access to care. “There have been improvements in patient experience over time, which is an encouraging sign,” Dr. Levine says. “The next step is to address the inconsistent gains in healthcare quality and disappointing absolute rates that were seen in our analysis.”

Looking Ahead

Ongoing national efforts to measure and improve the quality of outpatient care should continue, according to Dr. Levine. “We should have a renewed focus on identifying and disseminating successful improvement strategies so that we can optimize health outcomes,” he says. “These efforts are imperative as healthcare costs continue to rise.

David M. Levine, MD, MA, has indicated to Physician’s Weekly that he received funding support for the study discussed in this article from an Institutional National Research Service Award from the NIH (T32HP10251) and from the Ryoichi Sasakawa Fellowship Fund.



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