Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001

• Published in: JAMA : the journal of the American Medical Association Vol. 289; no. 3; pp. 305 - 312
• Main Authors: Jencks, Stephen F, Huff, Edwin D, Cuerdon, Timothy
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 15.01.2003
• Subjects: Aged; Ambulatory Care - standards; Biological and medical sciences; Comparative analysis; Cross-Sectional Studies; Fee-for-Service Plans - standards; General aspects; Health care delivery; Health Services Research; Health systems. Social services; Hospitals - standards; Humans; Medical sciences; Medicare; Medicare - standards; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Indicators, Health Care - statistics & numerical data; Quality of Health Care - classification; Quality of Health Care - trends; Quality of service; Total Quality Management - statistics & numerical data; United States; United States; North America; America; Human; Analytical indicator; Improvement; Information communication; Q factor; Performance requirement; Primary health care; Public health organization; Public health
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.289.3.305

CONTEXT: Despite widespread concern regarding the quality and safety of health care, and a Medicare Quality Improvement Organization (QIO) program intended to improve that care in the United States, there is only limited information on whether quality is improving. OBJECTIVE: To track national and state-level changes in performance on 22 quality indicators for care of Medicare beneficiaries. DESIGN, PATIENTS, AND SETTING: National observational cross-sectional studies of national and state-level fee-for-service data for Medicare beneficiaries during 1998-1999 (baseline) and 2000-2001 (follow-up). MAIN OUTCOME MEASURES: Twenty-two QIO quality indicators abstracted from state-wide random samples of medical records for inpatient fee-for-service care and from Medicare beneficiary surveys or Medicare claims for outpatient care. Absolute improvement is defined as the change in performance from baseline to follow-up (measured in percentage points for all indicators except those measured in minutes); relative improvement is defined as the absolute improvement divided by the difference between the baseline performance and perfect performance (100%). RESULTS: The median state's performance improved from baseline to follow-up on 20 of the 22 indicators. In the median state, the percentage of patients receiving appropriate care on the median indicator increased from 69.5% to 73.4%, a 12.8% relative improvement. The average relative improvement was 19.9% for outpatient indicators combined and 11.9% for inpatient indicators combined (P<.001). For all but one indicator, absolute improvement was greater in states in which performance was low at baseline than those in which it was high at baseline (median r = −0.43; range: 0.12 to −0.93). When states were ranked on each indicator, the state's average rank was highly stable over time (r = 0.93 for 1998-1999 vs 2000-2001). CONCLUSIONS: Care for Medicare fee-for-service plan beneficiaries improved substantially between 1998-1999 and 2000-2001, but a much larger opportunity remains for further improvement. Relative rankings among states changed little. The improved care is consistent with QIO activities over this period, but these cross-sectional data do not provide conclusive information about the degree to which the improvement can be attributed to the QIOs' quality improvement efforts.