Outpatient Care In The US Has Not Improved In Critical Areas: Study


A cross-sectional survey was analyzed to understand the level of outpatient care in the United States, and the results showed inconsistent improvements. From 2002 to 2013, four clinical quality indicators improved, while two performed worse and three did not change.

However, when it comes to patient experience, the numbers show amelioration.

The analysis was performed on trends examined over time, and the methodological measures were qualitative in nature. Dr. David M. Levine of Brigham and Women's Hospital and Harvard Medical School and coauthors published the paper in JAMA Internal Medicine.

The study's relevance in the socio-economic context of the United States lies in the widespread deficits that existed a decade ago in the health care system, which was followed by a series of measures designed to improve the quality of patient care. However, the reforms haven't changed the situation significantly.

"In recent years, these efforts have been complemented by an increasing focus on overuse through programs such as the American Board of Internal Medicine Foundation's Choosing Wisely initiative and increasing attention to patient-reported outcomes," the authors said.

There were 46 indicators of outpatient care quality, analyzing the performance of the medical services during the last decade. Aside from the conclusions of the study, the scientists also underlined the aging of the U.S. adult population, with the average age increasing from 45 to 47 years.

The scientific report underlined that the areas that showed improvement are: recommended medical treatment (a 6 percent growth, from 36 to 42 percent), recommended cancer screening (a 2 percent growth from 73 to 75 percent), recommended counseling (a 7 percent growth from 43 to 50 percent) and avoidance of inappropriate cancer screening (a 4 percent growth from 47 to 51).

Concerning the results that were unchanged for the last decade, there are three clinical quality measures as found by the study: recommended diagnostic and preventive testing (76 percent), recommended diabetes care (68 percent) and inappropriate imaging avoidance (90 percent).

However, the clinical criteria that recorded poorer performance during the last decade are avoidance of inappropriate medical treatment (a 4 percent decline from 92 to 89) and avoidance of inappropriate antibiotic use (a 6 percent decline from 50 to 44).

A 5 percent improvement was also observed in the care experience (from 72 to 77), while physician communication increased with 8 percent (from 55 to 63) and access to care improved by 10 percent (from 48 to 58).

"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," the study concluded.

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