Despite the increasing attention on health care quality improvement in the U.S., the national quality of outpatient health care services has not been assessed. Particularly lacking are rigorous evaluations of trends in the quality of outpatient care for racial and ethnic minorities. This application will address this issue using data from the 1992-2001 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS).
Its aims are to: 1) construct a set of outpatient quality indicators, 2) assess quality of care at the national level using the selected indicators, 3) evaluate time trends in these indicators, and 4) determine patient, physician and organizational predictors of quality of care, with a particular focus on racial/ethnic minorities. A set of 27 proposed quality indicators will provide a quantitative assessment of quality and will cover: 1) recommended medications (e.g., warfarin in atrial fibrillation), 2) antibiotic use (e.g., antibiotics in viral respiratory infections), 3) physician counseling/disease management (e.g., dietary counseling in diabetes), 4) diagnostic testing (e.g., screening urinalysis tests), and 5) medication errors (e.g., risky drug-drug interactions).

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS011313-03
Application #
6748178
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Kelley, Edward
Project Start
2002-07-01
Project End
2006-06-30
Budget Start
2004-07-01
Budget End
2006-06-30
Support Year
3
Fiscal Year
2004
Total Cost
Indirect Cost
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Ma, Jun; Xiao, Lan; Stafford, Randall S (2009) Underdiagnosis of obesity in adults in US outpatient settings. Arch Intern Med 169:313-4
Ma, Jun; Xiao, Lan; Stafford, Randall S (2009) Adult obesity and office-based quality of care in the United States. Obesity (Silver Spring) 17:1077-85
Ma, Jun; Stafford, Randall S (2008) Screening, treatment, and control of hypertension in US private physician offices, 2003-2004. Hypertension 51:1275-81
Wang, Y Richard; Alexander, G Caleb; Stafford, Randall S (2007) Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med 167:141-7
Ma, Jun; Lee, Ky-Van; Stafford, Randall S (2006) Changes in antihypertensive prescribing during US outpatient visits for uncomplicated hypertension between 1993 and 2004. Hypertension 48:846-52
Dai, Carolanne; Stafford, Randall S; Alexander, G Caleb (2005) National trends in cyclooxygenase-2 inhibitor use since market release: nonselective diffusion of a selectively cost-effective innovation. Arch Intern Med 165:171-7
Linder, Jeffrey A; Huang, Elbert S; Steinman, Michael A et al. (2005) Fluoroquinolone prescribing in the United States: 1995 to 2002. Am J Med 118:259-68