HealthDay News — According to an analysis published in JAMA Internal Medicine, efforts to improve the quality of clinical care in the US have had little impact on many aspects of outpatient care.

David Levine, MD, 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 US adult population to evaluate 46 quality indicators. These included measures of under-use and over-use 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.

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The percentage of adults rating their health care experiences an 8, 9 or 10 out of 10 rose from 72 to 77% over the study period. And patient ratings of access to care rose from 48 to 58%.

Among other findings from the study: about 1 in 4 Americans are not getting recommended diagnostic and preventive screenings; nearly 1 in 3 Americans fail to receive recommended diabetes care; and about 60% of eligible Americans do not receive beneficial cardiovascular and pulmonary therapies. 

Recommended colorectal cancer screenings improved, from 48 to 63% of eligible adults; however, the percentage of older adults who avoid inappropriate colorectal cancer screening fell, to 61% from 70%.


Levine DM, Linder JA, Landon BE. The Quality of Outpatient Care Delivered to Adults in the United States, 2002 to 2013. JAMA Intern Med. Published online October 17, 2016. doi:10.1001/jamainternmed.2016.6217.

McGlynn EA, Adams JL, Kerr EA. The Quest to Improve QualityMeasurement Is Necessary but Not Sufficient. JAMA Intern Med. Published online October 17, 2016. doi:10.1001/jamainternmed.2016.6233.

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