The quality of health care delivered to adults in the United States
The quality of health care delivered to adults in the United States
复制标题
DOI：
10.1056/nejmsa022615
复制
发表时间：
2003-06-26
影响因子：
158.5
通讯作者：
Kerr, EA
中科院分区：
文献类型：
--
作者：
McGlynn, EA;Asch, SM;Kerr, EA
背景：关于医疗保健（质量的关键要素）所涉及的标准流程在美国的实施程度，我们几乎没有系统的信息。 方法：我们随机抽取了居住在美国 12 个大都市地区的成年人，并询问他们有关选定的医疗保健经历的情况。我们还收到了复制他们最近两年的医疗记录的书面同意，并利用这些信息来评估 30 种急性和慢性疾病以及预防性护理的 439 项护理质量指标的表现。然后我们构建了总分。 结果：参与者接受了 54.9%（95% 置信区间，54.3 至 55.5）的推荐护理。我们发现，推荐的预防性护理的比例（54.9%）、推荐的急性护理的比例（53.5%）和推荐的慢性病护理的比例（56.1%）之间差异不大。在不同的医疗职能中，遵守护理流程的比例从筛查的 52.2% 到后续护理的 58.5%。根据特定的医疗状况，质量差异很大，从针对老年白内障的推荐护理的 78.7%（95% 置信区间，73.3 至 84.2）到针对酒精依赖的推荐护理的 10.5%（95% 置信区间，6.8 至 14.6）。 结论：我们在遵守基本护理推荐流程方面发现的缺陷对美国公众的健康构成了严重威胁。减少这些护理缺陷的策略是必要的。
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.