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Quality of Outpatient Care Has Not Consistently Improved in U.S.

Large analysis finds declines or stagnation in many basic health measures in the United States

MONDAY, Oct. 17, 2016 (HealthDay News) — Efforts to improve the quality of clinical care in the United States have had little impact on many aspects of outpatient care, according to an analysis published online Oct. 17 in JAMA Internal Medicine.

David Levine, M.D., an internist and research fellow at Brigham & Women’s Hospital and Harvard Medical School in Boston, and colleagues used data from a nationally representative annual survey of the U.S. adult population to evaluate 46 quality indicators. These included measures of underuse and overuse of medical treatments and patient experiences.

While the study showed modest gains in a few clinical care measures, other indicators of quality remained unchanged or even declined. Of clinical quality measures, appropriate use of β-blockers for heart failure and statin drugs for stroke showed the greatest improvement. At the same time, declines occurred in the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with both diabetes and hypertension. The percentage of adults rating their health care experiences an 8, 9 or 10 out of 10 rose from 72 to 77 percent over the study period. And patient ratings of access to care rose from 48 to 58 percent.

Among other findings from the study: about one in four Americans are not getting recommended diagnostic and preventive screenings; nearly one in three Americans fail to receive recommended diabetes care; and about 60 percent of eligible Americans do not receive beneficial cardiovascular and pulmonary therapies. Recommended colorectal cancer screenings improved, from 48 to 63 percent of eligible adults; however, the percentage of older adults who avoid inappropriate colorectal cancer screening fell, to 61 percent from 70 percent.

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