title: The quality of health care delivered to adults in the United States.
abstract: BACKGROUND
  We have little systematic information about the extent to which standard processes involved in health care--a key element of quality--are delivered in the United States.
  
  
  METHODS
  We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care. We then constructed aggregate scores.
  
  
  RESULTS
  Participants received 54.9 percent (95 percent confidence interval, 54.3 to 55.5) of recommended care. We found little difference among the proportion of recommended preventive care provided (54.9 percent), the proportion of recommended acute care provided (53.5 percent), and the proportion of recommended care provided for chronic conditions (56.1 percent). Among different medical functions, adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care. Quality varied substantially according to the particular medical condition, ranging from 78.7 percent of recommended care (95 percent confidence interval, 73.3 to 84.2) for senile cataract to 10.5 percent of recommended care (95 percent confidence interval, 6.8 to 14.6) for alcohol dependence.
  
  
  CONCLUSIONS
  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.
authors.affiliation: RAND, Santa Monica, Calif 90407, USA. beth_mcglynn@rand.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Joan
authors.initials: J
authors.lastname: Keesey
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hicks
authors.forename: Alison
authors.initials: A
authors.lastname: DeCristofaro
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000328:Adult; D003625:Data Collection; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013812:Therapeutics / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States