A study published Monday in the journal JAMA Internal Medicine revealed that the quality of outpatient care in the United States has not significantly improved between 2002 and 2013. Initiatives to enhance quality have had a mild impact in some areas, but positive results have rarely been observed on a national scale, the Boston research team wrote in the paper.
The study shows that American adults received only 50 percent of the recommended care required for 30 major causes of illness of death, which came as an awkward surprise for health professionals.
Efforts to reduce the number of unnecessary procedures and alternative payment models focused on rewarding effective care have not been enough, and the quality assessment by the research team was described as “anemic” by Elizabeth A. McGlynn, Ph.D., from Kaiser Permanent Research in Pasadena, California.
She and her colleagues wrote that these outcomes show that more must be done to improve the health of the American public.
“Despite more than a decade of efforts, the clinical quality of outpatient care delivered to American adults has not consistently improved,” the authors wrote, as quoted by Medscape.
One example that illustrates this is that one in four eligible Americans did not receive recommended cancer screening and the trend did not get better whatsoever over ten years said internist and study author David M. Levine, MD, from Brigham and Women’s Hospital in Boston. He noted that the trend even got worse in areas such as mammography and cervical cancer screening.
The research team also found that there has been wasteful spending as well as inappropriate use of medicines and treatments. Although substantial evidence reveals that antibiotics should not be given in these cases, about 50 percent of patients who needed care for a virus were prescribed these treatments.
And this is a severe issue. The study authors warned that patients taking unnecessary antibiotics are exposed to possible side effects and are at risk of prevalence of antibiotic-resistant bacteria. Unfortunately, the number of cases involving antibiotic prescription in the wrong cases significantly increased over the study period.
The research team believes that the current fee-for-service payments might be contributing to the poor progress of outpatient care quality as it may serve as an incentive for improper care. The authors added that efforts to reduce the effect of these incentives have little impact on quality.
It is worth noting that this analysis does not involve changes as a consequence of the Affordable Care Act or Obamacare given that it rolled out just three years ago and was, therefore, irrelevant to the study.
Researchers used data collected in 2002 and 2013 from the Medical Expenditure Panel Survey, which is an annual, representative survey of adults across the country. This information was corroborated by data from the patients’ clinicians, hospital, and employers.
The quality of visits to physicians, physician assistants, and nurse practitioners was examined. The authors also assessed 46 quality indicators such as measures of overuse and underuse of medical treatments and patient experiences, as reported by CBS News. They observed a mild improvement in scores for recommended medical treatment, recommended counseling, recommended cancer screening, and avoidance of inadequate cancer screening.
But composite scores worsened for a clinical avoidance of inappropriate medicaments or refraining from unnecessary antibiotic use. Scores remained steady for recommended use of diagnostic and preventive tests, recommended diabetes care, and avoidance of unnecessary imaging.
The researchers also observed that between 2002 and 2013, the American population became less white and more Hispanic, a little older, and less likely to smoke. Additionally, they found that the number of people going to college increased and the proportion of Americans diagnosed with three or more chronic diseases rose from 8 to 18 percent.
Quality improvement requires multiple efforts
Although increasing public reporting of quality measures can serve to raise awareness on the need to make more efforts to improve the health of Americans, it alone cannot solve the problem, the study commentators remarked. They believe that coordinated changes must be implemented in care delivery systems.
They also concluded that quality would not be improved as a consequence of a new payment reform.
“We need to find a more effective way to transform the delivery of health care so that physicians and patients can achieve the outcomes that both desire. This will be hard work and will require engagement on the ground and not simply exhortations from those paying the bills,” the researchers stated.
Source: CBS News