Quality of Ambulatory Care

Epidemiology and Comparison By Insurance Status and Income

Published in: Medical care, v. 28, no. 5, May 1990, p. 392-433

Posted on RAND.org on December 31, 1989

by Robert H. Brook, Caren Kamberg, Kathleen N. Lohr, George A. Goldberg, Emmett B. Keeler, Joseph P. Newhouse

Read More

Access further information on this document at www.lww.com

This article was published outside of RAND. The full text of the article can be found at the link above.

In this report the data from medical history questionnaires, screening examinations, insurance claims, and a face-to-face physician interview were used to examine the quality of ambulatory care received for 17 chronic conditions by a general population of 5986 adults (<=65) and children (<=14) enrolled in the RAND Health Insurance Experiment. Subjects in six U.S. sites were randomly assigned to insurance plans that were free or that required cost sharing, or in one site to an HMO. Quality-of-care criteria-both process (what was done to patients) and outcome (what happened to them)-were developed. Overall, 81% of outcome criteria and 62% of process criteria were met. Physicians interviewed patients with selected conditions at the Experiment's end to evaluate care. They suggested that approximately 70% of patients should have their current therapy changed, but only 30% of patients would obtain more than minor improvement from such a change. Clinically meaningful plan differences in quality of care were observed only for the process criteria dealing with the need for a visit (free plan compliance 59%; cost sharing compliance 52%). Quality of care for the poor was slightly worse than for the nonpoor and persons randomized to an HMO had slightly better overall quality of care than those in the fee-for-service system. Substantial improvements in the quality of the process of care could be made, but impact on outcome may be small. Results of the analysis suggest the need for development of clinical models to test the relationship between specific process criteria and improvements in outcome.

Research conducted by

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.