In its 2001 report Crossing the Quality Chasm, the Institute of Medicine outlined 6 domains of quality in medical care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.1 Anyone practicing medicine or receiving care probably agrees that quality should be defined broadly—as broadly as the IOM has outlined. However, current quality measures for the outpatient setting do not encompass many of these domains. As a result, quality measurement and quality improvement efforts in the outpatient setting have neglected critical domains of high-quality care.
The majority of outpatient quality measures focus on preventive care, chronic disease care, and patient experience. In 2005, the Ambulatory Care Quality Alliance Workgroup (an organization that included stakeholders from the American Academy of Family Physicians, American College of Physicians, America's Health Insurance Plans, and Agency for Healthcare Research and Quality) endorsed 25 ambulatory care measures.2 Only 2 measures (testing for pharyngitis and appropriate treatment for upper respiratory tract infections in children) were for the diagnosis and management of acute conditions. The remaining 23 measures were for preventive care and management of chronic disease. Similarly, of the 47 effectiveness-of-care measures in the 2013 Healthcare Effectiveness Data and Information Set, 36 are for preventive care and chronic disease management.3 Patient experience surveys such as the Consumer Assessment of Healthcare Providers and Systems survey focus on domains such as timeliness of care and patient-centeredness.
As a result, quality of care in the outpatient setting has become synonymous with preventive care and chronic disease management with some measures of patient experience. Safety, effectiveness, coordination, and efficiency are not captured in the current measures of outpatient quality.