title: The Quality of Outpatient Care Delivered to Adults in the United States, 2002 to 2013.
abstract: OBJECTIVE
  Widespread deficits in the quality of US health care were described over a decade ago. Since then, local, regional, and national efforts have sought to improve quality and patient experience, but there is incomplete information about whether such efforts have been successful.
  
  
  OBJECTIVE
  To measure changes in outpatient quality and patient experience in the United States from 2002 to 2013.
  
  
  METHODS
  We analyzed temporal trends from 2002 to 2013 using quality measures constructed from the Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the US population that collects data from individual respondents as well as respondents' clinicians, hospitals, pharmacies, and employers. Participants were noninstitutionalized US adults 18 years or older (range, 20 679-26 509 individuals each year).
  
  
  METHODS
  Outpatient quality measures were compiled through a structured review of prior studies and measures endorsed by national organizations. Nine clinical quality composites (5 "underuse" composites, eg, recommended medical treatment; 4 "overuse" composites, eg, avoidance of inappropriate imaging) based on 39 quality measures; an overall patient experience rating; and 2 patient experience composites (physician communication and access) based on 6 measures.
  
  
  RESULTS
  From 2002 to 2013 (MEPS sample size, 20 679-26 509), 4 clinical quality composites improved: recommended medical treatment (from 36% to 42%; P < .01), recommended counseling (from 43% to 50%; P < .01), recommended cancer screening (from 73% to 75%; P < .01), and avoidance of inappropriate cancer screening (from 47% to 51%; P = .02). Two clinical quality composites worsened: avoidance of inappropriate medical treatments (from 92% to 89%) and avoidance of inappropriate antibiotic use (from 50% to 44%; P < .01 for both comparisons). Three clinical quality measures were unchanged: recommended diagnostic and preventive testing (76%), recommended diabetes care (68%), and inappropriate imaging avoidance (90%). The proportion of participants highly rating their care experience improved for overall care (from 72% to 77%), physician communication (from 55% to 63%), and access to care (from 48% to 58%; P < .01 for all comparisons).
  
  
  CONCLUSIONS
  Despite more than a decade of efforts, the clinical quality of outpatient care delivered to American adults has not consistently improved. Patient experience has improved. Deficits in care continue to pose serious hazards to the health of the American public.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts2Harvard Medical School, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Levine
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts2Harvard Medical School, Boston, Massachusetts.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.affiliation: Harvard Medical School, Boston, Massachusetts3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts4Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
mesh_terms: D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003142:Communication; D003376:Counseling / Q000592:standards / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000628:therapy; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D019468:Disease Management; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents