Quality of US outpatient care has not improved consistently, study finds

Outpatient clinical care quality in America did not improve with consistency from 2002 to 2013, according to a study published in JAMA Internal Medicine.

Researchers measured changes in outpatient quality and patient experience in the United States from 2002 to 2013. They analyzed temporal trends using quality measures constructed from the Medical Expenditure Panel Survey, a nationally representative annual survey of the U.S. population. The survey polls adults as well as respondents' clinicians, hospitals, pharmacies and employers.

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The researchers measured 46 indicators of outpatient care quality and identified nine clinical quality composites based on 39 quality measures; an overall patient experience rating; and two patient experience composites based on six measures.

The investigators found that during the study period, four clinical quality composites improved. These are:

•    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)
•    Avoidance of inappropriate cancer screening (from 47 percent to 51 percent)

They found that two clinical quality composites worsened:

•    Avoidance of inappropriate medical treatments (from 92 percent to 89 percent)
•    Avoidance of inappropriate antibiotic use (from 50 percent to 44 percent)

The study shows that three clinical quality measures were unchanged:

•    Recommended diagnostic and preventive testing (76 percent)
•    Recommended diabetes care (68 percent)
•    Inappropriate imaging avoidance (90 percent)

Additionally, the percentage of respondents who highly rated their care experience improved for overall care from 72 percent to 77 percent.

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