A study published in JAMA Internal Medicine found that the quality of outpatient care has not consistently improved during the past decade and that inappropriate antibiotic prescribing and inappropriate use of medical treatments have worsened.

David M Levine, MD, from the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues sought to examine the changes in the quality of care and patient experience from 2002 to 2013. A number of local, regional, and national efforts have aimed to improve the quality of patient care in the United States during that time.

The researchers measured 46 indicators of the quality of outpatient care. They examined temporal trends using data from the Medical Expenditure Panel Survey (MEPS), which included data from individual respondents, clinicians, hospitals, pharmacies, and employers. They identified 9 clinical quality composites, including 5 “underuse” composites such as recommended cancer screening and 4 “overuse” composites such as the avoidance of imaging in certain clinical settings.

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“Although there were areas of improvement, including provision of recommended medical treatments, recommended counseling, and avoidance of inappropriate cancer screening, there were also areas of decline, including avoidance of inappropriate antibiotic prescribing and avoidance of inappropriate medical treatments,” the study authors wrote.

Four quality composites improved, including recommended medical treatments (36% to 42%), recommended counseling (43% to 50%), recommended cancer screening (73% to 75%), and avoidance of inappropriate cancer screening (47% to 51%).

However, the researchers found that the “avoidance of inappropriate medical treatments” worsened from 92% to 89% and the “avoidance of inappropriate antibiotic use” worsened from 50% to 44%. In addition, 3 quality measures were unchanged, including recommended diagnostic and preventive testing (76%), recommended diabetes care (68%), and inappropriate imaging avoidance (90%).

The percentage of patients who highly rated their care experience improved from 72% to 77%. The researchers also noted that physician communication improved from 55% to 63% and access to care improved from 48% to 58%.

“Current deficits in care continue to pose serious hazards to the health of the American public in the form of missed care opportunities as well as waste and potential harm from overuse,” the investigators wrote. “Ongoing national efforts to measure and improve the quality of outpatient care should continue, with a renewed focus on identifying and disseminating successful improvement strategies.”


  1. Levine DM, Linder JA, Landon BE. The quality of outpatient care delivered to adults in the United States, 2002 to 2013. JAMA Intern Med. 2016; doi: 10.1001/jamainternmed.2016.6217.