Inconsistent Improvements in Quality of Outpatient Care May be Hazardous to Public Health

Despite national improvement efforts, the clinical quality of outpatient care has not progressed consistently in the past decade, and the lack of solid improvement may have resulted in deficits of care that pose serious hazards to the health of the American public, according to a study published Oct. 17 in JAMA Internal Medicine.

David M. Levine, MD, MA, et al., analyzed temporal trends from 2002 to 2013 using quality measures constructed from the Medical Expenditure Panel Survey and identified nine clinical quality composites by which to measure improvement.

Results showed that four clinical quality composites improved: recommended medical treatment (from 36 percent to 42 percent), recommended counseling (from 43 percent to 50 percent), recommended cancer screening (from 73 percent to 75 percent) and avoidance of inappropriate cancer screening (from 47 percent to 51 percent). Two clinical quality composites worsened: avoidance of inappropriate medical treatments (from 92 percent to 89 percent) and avoidance of inappropriate antibiotic use (from 50 percent to 44 percent). Three clinical quality measures were unchanged: recommended diagnostic and preventive testing (76 percent), recommended diabetes care (68 percent) and inappropriate imaging avoidance (90 percent).

The authors did find improvements in patient experience with 72 percent vs. 77 percent of participants highly rating their overall care experience; 55 percent vs. 63 percent for physician communication; and 48 percent vs. 58 percent for access to care.

The authors note that improvement efforts since 2002 include expanded quality measurement and public reporting programs, increased adoption of pay-for-performance and value-based purchasing by payers, and several others.

“Despite more than a decade of efforts to improve the quality of health care in the U.S., the quality of outpatient care delivered to adults has not consistently improved,” the authors explain. “Current deficits in care continue to pose serious hazards to the health of the American public in the form of missed care opportunities as well as waste and potential harm from overuse. Ongoing national efforts to measure and improve the quality of outpatient care should continue, with a renewed focus on identifying and disseminating successful improvement strategies,” they conclude.

In an editorial comment, Elizabeth A. McGlynn, PhD, et al., assert that physicians and patients need to be more engaged in improvement efforts rather than just payers and policy makers. “Those approaches require time, resources, and energy that are beyond what is available to many practices that are struggling to keep up with a rapidly changing world,” they add.

Keywords: Ambulatory Care, Anti-Bacterial Agents, Counseling, Delivery of Health Care, Diabetes Mellitus, Early Detection of Cancer, Health Expenditures, Health Resources, Internal Medicine, Neoplasms, Public Health, Quality of Health Care, Reimbursement, Incentive, Value-Based Purchasing

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