Quality of care seen improving

The quality of medical care has improved slightly, but a gap still exists between care provided and evidence-based guidelines, according to a new study.

Researchers examined data on 23 quality indicators from 1992 and 2002 to gauge overall performance and racial and ethnic disparities in U.S. outpatient care. Significant improvements were found in only six of the 23 indicators studied, prompting researchers to say greater use of evidence-based medicine is needed.

"We really did not find much improvement. The gap remains wide between the best possible care and actual care of what patients receive," said Jun Ma, MD, PhD, research associate with California's Stanford University School of Medicine and lead author of the study published in the June 27 Archives of Internal Medicine.

But the federal Agency for Healthcare Research and Quality disputes that conclusion.

"We're finding that quality health care is improving across measures," said Dwight McNeill, PhD, an expert in quality improvement.

Dr. Ma and another researcher used data from two national surveys of outpatient care to measure overall performance and racial/ethnic disparities in physician offices and hospital outpatient departments in 1992 and 2002. Quality indicator performance was defined as the percentage of visits receiving appropriate care.

Changes were modest overall. Significant improvements were seen in treatment of depression, statin use for hyperlipidemia, inhaled corticosteroid use for asthma, avoiding routine urinalysis and avoiding inappropriate medications in the elderly.

Of the 23 indicators, only two showed statistical differences by race. Blacks were more likely than whites to receive ACE inhibitors to treat congestive heart failure. Whites were less likely to receive unnecessary antibiotics to treat common colds.

Dr. Ma said the finding does not mean racial and ethnic disparities do not exist. Dr. McNeill agreed. "We find that disparities are still pervasive," he said.

Some medical organizations are promoting quality improvements in physician practices. The AMA-led Physician Consortium for Performance Improvement has developed performance measure sets that primary care physicians can use.