Review of 46 indicators of outpatient care quality showed mixed results, with marginal gains in some areas and declining quality in others.
Marginal quality improvements seen in recommended medical treatments, counseling and cancer screening, and avoidance of inappropriate cancer screenings, while recommended diagnostic and preventive testing, recommended diabetes care, and inappropriate imaging avoidance were unchanged, and avoidance of inappropriate medical treatments and inappropriate antibiotic use worsened.
Excerpt: “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.”
“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.”
Source: Physician’s Weekly
WBB Take: A key component of the solution to high U.S. healthcare costs and poor patient outcomes is to shift much of the delivery toward primary care (PC) and away from inpatient and specialist care. Moving care to the PC end of the spectrum may allow earlier intervention in the progression of illness, and at a point where care delivery is cheaper, less invasive, and has fewer safety risks. However, if PC quality and safety do not improve over previous levels, increased utilization of PC services may not achieve these goals, but may instead result in increased waste and cost, and inferior patient outcomes.
Closer examination of PC technology deployment, policy implementation, and workflow may provide opportunities for Quality Improvement (QI) interventions. QI interventions can be prioritized based on the current performance gaps, and focus first on avoidance of inappropriate medical treatments and inappropriate antibiotic use, followed by recommended diagnostic and preventive testing, recommended diabetes care, and inappropriate imaging avoidance.
Cited by Matthew Loxton