Who Is at Greatest Risk for Receiving Poor-Quality Health Care?

Asch, Steven M.; Kerr, Eve A.; Keesey, Joan; Adams, John; Setodji, Claude Messan; Malik, Shaista; McGlynn, Elizabeth A.

doi:10.1056/nejmsa044464

Cited by 446 publications

(310 citation statements)

References 23 publications

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“…The lower rate of recommended care among older adults might be related to the higher number of indicators for which older adults became eligible or to lower attention to preventive care. Our findings of lower preventive care in the elderly are similar to those of a previous US study, 2 but need to be confirmed by further research. The higher level of quality of care for CVRFs compared to preventive care might be explained by the ease of ordering laboratory tests or prescribing new medications compared to counseling on lifestyle modifications or cancer screening.…”

Section: -11supporting

confidence: 87%

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The Quality of Primary Care in a Country with Universal Health Care Coverage

et al. 2011

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BACKGROUND:Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage. OBJECTIVE: To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage. DESIGN AND PARTICIPANTS: Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university primary care settings. MAIN MEASURES: We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator. KEY RESULTS: Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p<0.001 for comparisons with blood pressure and weight measurements). Eightythree percent of patients received the recommended care for cardiovascular risk factors, including >75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p<0.001) and patients <65 years (70.1% vs 68.0% in those ≥65 years, p=0.047). CONCLUSIONS: Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.KEY WORDS: quality of health care; insurance coverage; primary health care; primary prevention.

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Section: -11supporting

confidence: 87%

“…We selected 37 quality indicators from RAND's QA Tools 1,2 concerning preventive care and the care of CVRFs. This system was previously developed in the US to evaluate the quality of care delivered to adults.…”

Section: Quality Indicatorsmentioning

confidence: 99%

The Quality of Primary Care in a Country with Universal Health Care Coverage

et al. 2011

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“…In the U.S., Asch et al showed that ethnicity moderately determines overall quality of care: In terms of preventive care, hispanics had statistically significant higher scores than other ethnic group. 2 Higher overall scores of quality of care were found for young patients (<31 years) than the elderly (>64 years), women than men, Blacks and Hispanics than Caucasians and those with a high income (>$50,000) than those with incomes of less than $15,000. 2 Most other US studies focused on specific indicators or conditions making a comparison with our results difficult and found moderate variation of quality of care among different ethnic groups.…”

Section: Discussionmentioning

confidence: 90%

“…2 Higher overall scores of quality of care were found for young patients (<31 years) than the elderly (>64 years), women than men, Blacks and Hispanics than Caucasians and those with a high income (>$50,000) than those with incomes of less than $15,000. 2 Most other US studies focused on specific indicators or conditions making a comparison with our results difficult and found moderate variation of quality of care among different ethnic groups. 10,11 Gray et al showed that in the UK, non-Whites were significantly less likely to meet the national treatment targets for hemoglobin A1c, blood pressure, and cholesterol.…”

Section: Discussionmentioning

confidence: 90%