Titre :
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Change in the quality of care delivered to medicare beneficiaries, 1998-1999 to 2000-2001. (2003)
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Auteurs :
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Stephen-F JENCKS ;
Timothy CUERDON ;
Edwin-D HUFF
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Type de document :
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Article
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Dans :
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JAMA - Journal of the american medical association (vol. 289, n° 3, 2003)
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Pagination :
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305-312
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Langues:
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Anglais
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Mots-clés :
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Soins santé primaire
;
Amélioration
;
Etats Unis
;
Amérique
;
Homme
;
Amérique du Nord
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Résumé :
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[BDSP. Notice produite par INIST-CNRS fR0xStvM. Diffusion soumise à autorisation]. 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<. for all but one indicator absolute improvement was greater in states which performance low at baseline than those it high r="-0.43" range : to when were ranked on each the state average rank highly stable over time vs conclusions care medicare fee-for-service plan beneficiaries improved substantially between and a much larger opportunity remains further improvement. relative rankings among changed little. is consistent with qio activities this period these cross-sectional data do not provide conclusive information about degree can be attributed qios efforts.>
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