The Quality of Health Care Delivered to Adults in the United States

McGlynn, Elizabeth A.; Asch, Steven M.; Adams, John; Keesey, Joan; Hicks, Jennifer; DeCristofaro, Alison H.; Kerr, Eve A.

doi:10.1056/nejmsa022615

Cited by 4,391 publications

(2,839 citation statements)

References 42 publications

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“…Low adherence to quality indicators for treating various diseases has been found in many US health care systems (6,7), particularly for treatment of musculoskeletal diseases including rheumatoid arthritis (8), acute low back pain (6), and osteoarthritis (9), with quality scores ranging from 54% to 65%. MacLean et al (8) studied patients with rheumatoid arthritis enrolled in a nationwide US insurance company and reported quality scores of 62% for arthritis care, 52% for comorbid disease care, and 42% for health care maintenance.…”

Section: Introductionmentioning

confidence: 99%

Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

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174

109

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Objective. To examine evidence-based quality indicators (QIs) in US veterans with gout diagnosis, and to examine the effect of demographics, heath care utilization/access, comorbid conditions, or physican characteristics as predictors of quality of gout care. Methods. Using the Minneapolis Veterans Affairs electronic medical record system, we identified a cohort of veterans receiving medication to treat gout between January 1, 1999 and December 31, 2003, and evaluated 3 recently published evidence-based QIs for gout management: QI 1 ‫؍‬ allopurinol dose <300 mg in gout patients with renal insufficiency, QI 2 ‫؍‬ uric acid check within 6 months of starting a new allopurinol prescription, and QI 3 ‫؍‬ complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy. We calculated the proportion of patients whose therapy adhered to each QI and to all applicable indicators (overall physician adherence). Logistic regression analysis examined association of overall physician adherence with sociodemographics, health care utilization, comorbidity, and provider characteristics. Results. Of 3,658 patients with a diagnosis of gout, 663 patients qualified for examination of >1 QI. Of these 663 patients, therapy in only 144 (22%) adhered to all applicable QIs; 59 (78%) of 76 adhered to QI 1, 155 (24%) of 643 adhered to QI 2, and 18 (35%) of 52 adhered to QI 3. Overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year, but was higher in those with more primary care visits or more health care providers. Conclusion. Suboptimal physician adherence to QIs was seen for all 3 QIs tested in this cohort of veterans with gout. These findings can guide quality improvement efforts.

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Section: Introductionmentioning

confidence: 99%

Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

Self Cite

174

109

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“…46,47 For example, Birkmeyer et al showed the ratio of the highest to the lowest hospital referral regions for carotid endarterectomy for Medicare enrollees in the USA to be approximately 10 to 1. 46 Variation based on differences between patients is appropriate, but this variation was not explained by case mix or even by differences in resource.…”

Section: Variation In Health Carementioning

confidence: 99%

“…46,47 Par exemple, Birkmeyer et coll. ont montré que l'incidence de consultations pour une endartériectomie carotidienne pour les patients inscrits à Medicare aux É tats-Unis variait d'un facteur d'à peu près 10 entre la région ayant la plus grande incidence et celle dont l'incidence était la plus faible.…”

Section: Les Variations Dans Les Soins De Santéunclassified

An overview of quality and safety in health care

Merry

2012

Can J Anesth/J Can Anesth

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“…3 In the 14 years since Donabedian's death, the quality landscape has changed markedly and has moved from a more general awareness of quality chasms in health care to broader policy efforts designed to proactively assess quality and improve care. [4][5][6][7][8] Central to these efforts, the best way to measure quality is as pertinent a question today as it was in 2000. Resoundingly, however, structure, process, and outcome measures that evaluate the context and setting of care, the way in which care is delivered, and the effects of that care have become the main linchpins in quality assessment and improvement programs.…”

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confidence: 99%

Revisiting structure, process, and outcome

Gilbert

2014

Cancer

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Nearly 4 decades after first describing the structure-process-outcome framework for assessing quality in health care, Dr. Avedis Donabedian outlined some of the shortfalls in his own care during an interview published in Health Affairs. 1,2 Treated earlier in his life for prostate cancer, Donabedian was diagnosed with bladder cancer years later after worsening urinary symptoms and episodes of urinary obstruction, infections, and renal failure led to the detection of a tumor in his bladder. Urine cytology, commonly used to evaluate a patient for bladder cancer, was performed at some point before the diagnosis but went unchecked for months (James Montie, MD, oral communication). The results were abnormal. Donabedian ultimately had his bladder removed, and he lived the remaining few years of his life with "lots of permanent tubes and pouches." 2 He died on November 9, 2000 of metastatic cancer. 3 In the 14 years since Donabedian's death, the quality landscape has changed markedly and has moved from a more general awareness of quality chasms in health care to broader policy efforts designed to proactively assess quality and improve care. [4][5][6][7][8] Central to these efforts, the best way to measure quality is as pertinent a question today as it was in 2000. Resoundingly, however, structure, process, and outcome measures that evaluate the context and setting of care, the way in which care is delivered, and the effects of that care have become the main linchpins in quality assessment and improvement programs. To date, the National Quality Forum has vetted and endorsed more than 460 quality indicators, 9 many of which underpin high-profile quality improvement programs such as the Physician Quality Reporting System and the Hospital Inpatient Quality Reporting Program of the Centers for Medicare & Medicaid Services. 10,11 Within the realm of urology, National Quality Forum-endorsed quality measures have been limited mainly to urinary incontinence and prostate cancer thus far. 9 Bladder cancer quality indicators have been proposed by some groups, but they have not yet been adopted or implemented into actionable measures at a national level. 12,13 In this issue of Cancer, Chamie et al 14 further probe quality gaps in the management of bladder cancer. Leveraging the Los Angeles Surveillance, Epidemiology, and End Results cancer registry and supporting information abstracted from operative and pathology reports, they critically evaluate and link a meaningful and probably inarguable measure of quality-the presence of muscle on endoscopic biopsy/resection-to outcome, in this case, mortality, on a relatively large scale. Adequate muscle sampling at the time of transurethral bladder tumor resection has been examined in a number of prior studies and linked to an increased risk of understaging and higher rates of disease recurrence. 15,16 As a result, ensuring adequate muscle sampling during bladder tumor resection has become a standard principle across bladder cancer guidelines, particularly in the setting of invasive high-gr...

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The Quality of Health Care Delivered to Adults in the United States

Abstract: The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits in care are warranted.

Cited by 4,391 publications

References 42 publications

Quality of care for gout in the US needs improvement

Quality of care for gout in the US needs improvement

An overview of quality and safety in health care

Revisiting structure, process, and outcome

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