Outpatient providers struggle with improving quality

hospital building with a sign that says outpatient

Photo credit: Getty/Mark Winfrey

As healthcare shifts away from an inpatient-centric model, providing quality outpatient care is essential, but efforts to improve its quality leave much to be desired.

Researchers, led by David Levine, M.D., of Brigham & Women’s Hospital and Harvard Medical School, analyzed office-based care, involving nurse practitioners, physician assistants and doctors, from 2002 through 2013. They found serious deficits in outpatient care during this period, according to research published in JAMA Internal Medicine. For example, during the study period, 25 percent of eligible patients didn’t undergo the cancer screenings recommended by experts.

“That didn’t change at all over 10 years and, in fact, got worse in places like mammography and cervical cancer screening,” Levine told CBS News.  Meanwhile, about half of outpatients were prescribed antibiotics for viral infections, which flies in the face of evidence suggesting such treatment is ineffective, according to the study.

Providers seeking to improve these measures should look to the example of high-performing systems, Elizabeth McGlynn of Kaiser Permanente’s Center for Effectiveness and Safety Research wrote in an accompanying commentary. For example, nearly two decades ago, Kaiser Permanente leaders, in an effort to improve patients’ blood pressure control, developed a registry to monitor performance and integrate nurses, pharmacists and primary care teams. While replicating such a system would be an uphill struggle for most smaller providers, it would be particularly difficult where care is not properly integrated.

“This approach requires that everyone in the organization is engaged in improvement from the leadership to the front lines, which is difficult to accomplish in systems that are not integrated and provide an uncertain and unpredictable portion of care for an individual,” she wrote. “Because many people in the United States still receive care in nonintegrated systems, the failure to observe progress in quality in light of what is required for high-performing systems is perhaps not surprising.”