 |
|
Quality of US Outpatient Care
Temporal Changes and Racial/Ethnic Disparities
Jun Ma, MD, PhD;
Randall S. Stafford, MD, PhD
Arch Intern Med. 2005;165:1354-1361.
Background The current national measure set for the quality of health care underrepresents the spectrum of outpatient care and makes limited use of readily available national ambulatory care survey data.
Methods We examined 23 outpatient quality indicators in 1992 and again in 2002 to measure overall performance and racial/ethnic disparities in outpatient care in the United States. The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey yielded information about ambulatory services provided in private physician offices and hospital outpatient departments, respectively. Quality indicator performance was defined as the percentage of applicable visits receiving appropriate care.
Results In 2002, mean performance was 50% or more of applicable visits for 12 quality indicators, 7 of which were in the areas of appropriate antibiotic use and avoiding unnecessary routine screening. The performance of the remaining 11 indicators ranged from 15% to 42%. Overall, changes between 1992 and 2002 were modest, with significant improvements in 6 indicators: treatment of depression (47% vs 83%), statin use for hyperlipidemia (10% vs 37%), inhaled corticosteroid use for asthma in adults (25% vs 42%) and children (11% vs 36%), avoiding routine urinalysis during general medical examinations (63% vs 73%), and avoiding inappropriate medications in the elderly (92% vs 95%). After adjusting for potential confounders, race/ethnicity did not seem to affect quality indicator performance, except for greater angiotensin-converting enzyme inhibitor use for congestive health failure among blacks and less unnecessary antibiotic use for uncomplicated upper respiratory tract infections among whites.
Conclusions Measurable quality deficits and modest improvements across time call for greater adherence to evidence-based medicine in US ambulatory settings. Although significant racial disparities have been described in a variety of settings, we observed that similar, although less than optimal, care is being provided on a per-visit basis regardless of patient racial/ethnic background.
Author Affiliations: Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED LETTER
Clopidogrel in Patients With Acute Coronary Syndromes: Learning From Clinical Practice—Reply
Pierluigi Tricoci, Matthew T. Roe, and Eric D. Peterson
Arch Intern Med. 2006;166(20):2293.
EXTRACT
| FULL TEXT
RELATED ARTICLES
The Annual Physical: Are Physicians and Patients Telling Us Something?
Patrick G. O’Malley and Philip Greenland
Arch Intern Med. 2005;165(12):1333-1334.
EXTRACT
| FULL TEXT
Support of Evidence-Based Guidelines for the Annual Physical Examination: A Survey of Primary Care Providers
Allan V. Prochazka, Kristy Lundahl, Wesley Pearson, Sylvia K. Oboler, and Robert J. Anderson
Arch Intern Med. 2005;165(12):1347-1352.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Differences in Specialist Consultations for Cardiovascular Disease by Race, Ethnicity, Gender, Insurance Status, and Site of Primary Care
Cook et al.
Circulation 2009;119:2463-2470.
ABSTRACT
| FULL TEXT
Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage
McWilliams et al.
ANN INTERN MED 2009;150:505-515.
ABSTRACT
| FULL TEXT
Patient-Physician Connectedness and Quality of Primary Care
Atlas et al.
ANN INTERN MED 2009;150:325-335.
ABSTRACT
| FULL TEXT
Death Toll From Uncontrolled Blood Pressure in Ethnic Populations: Universal Access and Quality Improvement May Not Be Enough
Cene and Cooper
Ann Fam Med 2008;6:486-489.
FULL TEXT
Quality of Care for Children Hospitalized With Asthma
Nkoy et al.
Pediatrics 2008;122:1055-1063.
ABSTRACT
| FULL TEXT
Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States
Fiscella and Holt
J Am Board Fam Med 2007;20:587-597.
ABSTRACT
| FULL TEXT
The Quality and Safety of Ambulatory Medical Care: Current and Future Prospects
Moskowitz and Nash
American Journal of Medical Quality 2007;22:274-288.
Electronic Health Record Use and the Quality of Ambulatory Care in the United States
Linder et al.
Arch Intern Med 2007;167:1400-1405.
ABSTRACT
| FULL TEXT
Clopidogrel in Patients With Acute Coronary Syndromes: Learning From Clinical Practice--Reply
Tricoci et al.
Arch Intern Med 2006;166:2293-2293.
FULL TEXT
The Quality Of Chronic Disease Care In U.S. Community Health Centers
Hicks et al.
Health Aff (Millwood) 2006;25:1712-1723.
ABSTRACT
| FULL TEXT
Relationship between quality of care and racial disparities in medicare health plans.
Trivedi et al.
JAMA 2006;296:1998-2004.
ABSTRACT
| FULL TEXT
Improving the quality of preventive cardiovascular care provided by primary care physicians: insights from a US Quality Improvement Organization
Meehan et al.
Int J Qual Health Care 2006;18:186-194.
ABSTRACT
| FULL TEXT
Trends in racial disparities in care.
Kuller et al.
NEJM 2005;353:2081-2085.
FULL TEXT
The Annual Physical: Are Physicians and Patients Telling Us Something?
O'Malley and Greenland
Arch Intern Med 2005;165:1333-1334.
FULL TEXT
|
