The quality of health care delivered to adults in the United States - PubMed (original) (raw)
. 2003 Jun 26;348(26):2635-45.
doi: 10.1056/NEJMsa022615.
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- PMID: 12826639
- DOI: 10.1056/NEJMsa022615
Free article
The quality of health care delivered to adults in the United States
Elizabeth A McGlynn et al. N Engl J Med. 2003.
Free article
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.
Copyright 2003 Massachusetts Medical Society
Comment in
- Improving the quality of care--can we practice what we preach?
Steinberg EP. Steinberg EP. N Engl J Med. 2003 Jun 26;348(26):2681-3. doi: 10.1056/NEJMe030085. N Engl J Med. 2003. PMID: 12826644 No abstract available. - Quality of health care delivered to adults in the United States.
Spiegel M, Pechlaner C. Spiegel M, et al. N Engl J Med. 2003 Nov 6;349(19):1866-8; author reply 1866-8. doi: 10.1056/NEJM200311063491916. N Engl J Med. 2003. PMID: 14602886 No abstract available. - Quality of health care delivered to adults in the United States.
Sheikh K. Sheikh K. N Engl J Med. 2003 Nov 6;349(19):1866-8; author reply 1866-8. N Engl J Med. 2003. PMID: 14606460 No abstract available. - Quality of health care delivered to adults in the United States.
Goss JR, Elmore JG, Lessler DS. Goss JR, et al. N Engl J Med. 2003 Nov 6;349(19):1866-8; author reply 1866-8. N Engl J Med. 2003. PMID: 14606462 No abstract available.
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