Quality of US outpatient care - Temporal changes and racial/ethnic disparities
Quality of US outpatient care - Temporal changes and racial/ethnic disparities
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DOI：
10.1001/archinte.165.12.1354
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发表时间：
2005-06-27
影响因子：
--
通讯作者：
Stafford, RS
中科院分区：
文献类型：
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作者：
Ma, J;Stafford, RS
背景资料：目前的国家措施，为医疗保健的质量underrepresented的频谱门诊护理，并利用有限的现成的全国门诊护理survey data.Methods：我们研究了23个门诊质量指标在1992年，并再次在2002年，以衡量整体表现和种族/民族的差异，在美国的门诊护理。全国门诊医疗服务调查和全国医院门诊医疗服务调查分别提供了关于私人医生办公室和医院门诊部提供的门诊服务的信息。结果：2002年12项质量指标的平均绩效为50%或以上，其中7项是在适当使用抗生素和避免不必要的常规筛查方面，其余11项指标的绩效范围为15%~ 42%。总的来说，1992年至2002年期间的变化不大，有6项指标有显著改善：治疗抑郁症（47% vs 83%）使用他汀类药物治疗高脂血症（10% vs 37%），成人使用吸入性皮质类固醇治疗哮喘（251，对42%）和儿童（11%对36%），避免常规尿液分析在一般医疗检查（63%对73%），并避免不适当的药物在老年人（92%对95%）。调整潜在的混杂因素后，种族/民族似乎并没有影响质量指标的性能，除了更多的血管紧张素转换酶抑制剂使用的充血性健康衰竭的黑人和不必要的抗生素使用的简单的上呼吸道感染的白人，结论：可测量的质量缺陷和适度的改善随着时间的推移，要求更大的坚持循证医学在美国门诊设置。尽管在各种环境中描述了显著的种族差异，但我们观察到，无论患者种族/民族背景如何，每次访视都提供了类似的（尽管不是最佳的）护理。
Background: The current national measure set for the quality of health care underrepresents the spectrum of outpatient care and makes limited use of readily available national ambulatory care survey data.Methods: We examined 23 outpatient quality indicators in 1992 and again in 2002 to measure overall performance and racial/ethnic disparities in outpatient care in the United States. The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey yielded information about ambulatory services provided in private physician offices and hospital outpatient departments, respectively. Quality indicator performance was defined as the percentage of applicable visits receiving appropriate care.Results: In 2002, mean performance was 50% or more of applicable visits for 12 quality indicators, 7 of which were in the areas of appropriate antibiotic use and avoiding unnecessary routine screening, The performance of the remaining 11 indicators ranged from 15% to 42%. Overall, changes between 1992 and 2002 were modest, with significant improvements in 6 indicators: treatment of depression (47% vs 83%) statin use for hyperlipidemia (10% vs 37%), inhaled corticosteroid use for asthma in adults (251, vs 42%) and children (11% vs 36%), avoiding routine urinalysis during general medical examinations (63% vs 73%), and avoiding inappropriate medications in the elderly (92% vs 95%). After adjusting for potential confounders, race/ethnicity did not seem to affect quality indicator performance, except for greater angiotensin-converting enzyme inhibitor use for congestive health failure among blacks and less unnecessary antibiotic use for uncomplicated upper respiratory, tract infections among whites,Conclusions: Measurable quality deficits and modest improvements across time call for greater adherence to evidence-based medicine in US ambulatory settings. Although significant racial disparities have been described in a variety of settings, we observed that similar, although less than optimal, care is being provided on a per-visit basis regardless of patient racial/ethnic background.