National Trends in Outpatient Quality Indicators

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DESCRIPTION: Despite the increasing attention on health care quality improvement in the U.S., the national quality of outpatient health care services has not been assessed. Particularly lacking are rigorous evaluations of trends in the quality of outpatient care for racial and ethnic minorities. This application will address this issue using data from the 1992-2001 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS). Its aims are to: 1) construct a set of outpatient quality indicators, 2) assess quality of care at the national level using the selected indicators, 3) evaluate time trends in these indicators, and 4) determine patient, physician and organizational predictors of quality of care, with a particular focus on racial/ethnic minorities. A set of 27 proposed quality indicators will provide a quantitative assessment of quality and will cover: 1) recommended medications (e.g., warfarin in atrial fibrillation), 2) antibiotic use (e.g., antibiotics in viral respiratory infections), 3) physician counseling/disease management (e.g., dietary counseling in diabetes), 4) diagnostic testing (e.g., screening urinalysis tests), and 5) medication errors (e.g., risky drug-drug interactions).