Quality Healthcare: Decades of Work for Minor Movement

October 26, 2016
Jeannette Y. Wick, RPh, MBA, FASCP

Innovators have implemented pay-for-performance mandates, value-based purchasing, electronic health systems, and meticulous reporting programs. But has the quality of care or patient satisfaction improved?

The US healthcare system has, in theory, developed an extensive continuous quality improvement process over time. Innovators have implemented pay-for-performance mandates, value-based purchasing, electronic health systems, and meticulous reporting programs. But has the quality of care or patient satisfaction improved? Previous investigations have focused on a few quality measures, certain diseases, or Medicare patients only.

Now, an article published on October 17, 2016 in JAMA Internal Medicine suggests quality is unimproved—yet patients are more satisfied with their care.

The investigators scrutinized trends in the Medical Expenditure Panel Survey, an annual survey of the US population, from 2002 to 2013 for quality and patient satisfaction measures. The researchers indicate that readers should know that the demographic reflects "… an American population that became, on average, 1.6 years older, slightly poorer, and accrued more health conditions, although with unchanged self-rated general health status."

Some areas have improved. Compared to a decade ago, the U.S. healthcare system provides recommended medical treatments and counseling more often and more appropriately. Clinicians tend to be less likely to recommend inappropriate cancer screening.

Several areas remain deficient. Antibiotic stewardship has not limited inappropriate antibiotic use and unnecessary medical procedures still common. One-quarter of diabetics do not receive the care they need. Approximately 17% of Americans who saw a clinician for back pain received an inappropriate lumbar radiograph, which exposed them to the equivalent of 70 chest x-rays.

The US patient population is optimistic about their health as they age and get sicker, and this may contribute to their improved opinion about the quality of their care.

Many experts believe that fee-for-service provides disincentives to reducing care costs and improving care quality. Fee-for-service lacks developed feedback mechanisms related to outcomes unlike integrated care networks. Further, the current system lacks patient incentives to seek primary care before conditions escalate. It also reimburses primary care providers inadequately. The patient-centered medical home may embrace patient outcomes but past results are inconclusive.

Care quality did not improve appreciably between 2002 and the onset of the Affordable Care Act in 2013. Future initiatives should strive to limit waste and harm through innovative strategies on the national level.

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