How often do adults receive recommended health care?

Adults in 12 communities received only 55 percent of recommended health care on average, ranging from 11 percent to 79 percent across 30 acute and chronic conditions and preventive care. More than one of 10 patients received care that could do more harm than good, while almost one-half did not receive care that would have been beneficial for their condition.

Why is this important?

Understanding how well the health care system meets quality standards across multiple clinical conditions provides insight into the level of quality provided to the average adult while identifying areas for national improvement.

To meet this need, the RAND Corporation, a nonprofit research institute, interviewed adult patients in 12 communities and obtained permission to study their medical records. The researchers measured patients' health care using 439 evidence-based and expert-recommended quality indicators for 30 acute and chronic health conditions and preventive care (McGlynn et al. 2003).

Findings

Adult patients in 12 communities did not receive 45 percent of recommended health care on average between 1998 and 2000. Almost one-half of individuals did not receive services that would have been beneficial (underuse of effective care), whereas one of 10 received nonrecommended care that might do more harm than good (overuse of services). Among the conditions studied, quality was best for treatment of adult-onset eye cataracts, but still failed to meet expert standards 21 percent of the time. Quality was poorest for treatment of alcohol dependence, which failed to meet expert standards 89 percent of the time. Overall quality scores were consistently poor across all types of care (acute, chronic, preventive), functions of care (screening, diagnosis, treatment, follow-up), and cities in which the study was conducted (data not shown) (McGlynn et al. 2003).

Implications

Quality of health in America is often suboptimal. Improving the quality of care received by Americans not only improves individual patient health but also bolsters the overall health and productivity of the nation.

Improvement Ideas and Resources

At the community level, the study authors note the potential for community-wide collaborations to improve quality (Kerr et al. 2004). At the national level, the Institute of Medicine of the National Academy of Sciences has issued a series of reports recommending strategies for improving the quality of health care in America, among them:

• Redesign of local health care delivery systems accompanied by public policies to promote quality through regulatory and payment incentives and application of health information technologies (IOM 2001, 2004).
• Leadership by the federal government, which can influence the performance of the health care system through its oversight of six major health care programs serving nearly 100 million Americans (IOM 2003b, 2006a).
• National demonstration projects to foster rapid advances in improving primary and chronic care, using information and communications technology, expanding insurance coverage, and reforming state liability systems (IOM 2002).
• Implementation of a core set of competencies and approaches to health professional education so that it better prepares clinicians to meet the needs of patients and a high performance health care system (IOM 2003a).
• The creation of a common infrastructure, led by a National Quality Coordination Board, for guiding and managing the selection and use of a consistent set of quality measures nationally and regionally (IOM 2006b).

Measure:

Information was obtained from telephone interviews with a random sample of more than 13,000 civilian, noninstitutionalized adults (ages 18 and older) living in 12 U.S. communities and from the medical records of 6,700 who had a medical visit during the study period and provided permission. Individuals were included in the denominator each time they were eligible for a particular indicator. Indicators were scored at the participant level (e.g., influenza vaccination), the patient-provider dyad level (e.g., smoking cessation counseling at a medical visit), or the episode level (e.g., follow-up after hospitalization for mental illness). The numerator includes the number of times the individual received the recommended care corresponding to a particular indicator between 1998 and 2000 (McGlynn et al. 2003).Quality indicators were derived from the RAND Quality Assessment Tools system, focusing on acute and chronic conditions that represent the most prevalent causes of illness, death, and use of health care services for each age group, and preventive services related to these conditions. (Condition-specific results are not shown for five conditions because of small sample size.) Indicators were derived from national guidelines and the medical literature and were validated by multispecialty expert panels (McGlynn et al. 2003).

Limitations:

Results might be biased to the degree that individuals who consented to the use of their medical records differ from other individuals. Based on studies comparing medical records with other sources of information, the authors estimated that the results could be up to 10 percentage points higher using a different source of data (McGlynn et al. 2003).

Source:

Data are derived from the Community Quality Index study, a follow-on to the Community Tracking Study, which monitors changes in health care markets in the United States. Data were compiled by researchers from RAND, Santa Monica, Calif.; the University of California, Los Angeles; and the University of Michigan, Ann Arbor (Kerr et al. 2004; McGlynn et al. 2003).

References:

* Indicates source of data used in the chart(s).IOM (Institute of Medicine). 2001. Crossing the Quality Chasm: A New Health System for the 21st century. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 2002. Fostering Rapid Advances in Health Care: Learning from System Demonstrations. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 2003a. Health Professions Education: A Bridge to Quality. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 2003b. Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 2004. The 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 2006a. Medicare's Quality Improvement Organization Program: Maximizing Potential. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 2006b. Performance Measurement: Accelerating Improvement. Washington, D.C.: National Academy Press. Kerr, E. A., E. A. McGlynn, J. Adams et al. 2004. Profiling the Quality of Care in Twelve Communities: Results from the CQI Study. Health Affairs (Millwood) 23 (3): 247–56. * McGlynn, E. A., S. M. Asch, J. Adams et al. 2003. The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 348 (26): 2635–45.