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INTRODUCTION

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Each year in the United States, millions of people visit hospitals, physicians, and other caregivers and receive medical care of superb quality. But that’s not the whole story. Some patients’ interactions with the health care system fall short (Institute of Medicine, 1999, 2001) and widespread quality improvement has proven elusive (Chassin & Loeb, 2011).

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At the beginning of the 21st century, an estimated 32,000 people died in US hospitals each year as a result of preventable medical errors (Zahn & Miller, 2003). A 2013 study suggests that the actual number is higher (James, 2013). The rate of patient harms caused by care delivered in hospitals did not change from 2002 through 2007 (Landrigan et al., 2010).

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In addition, an estimated 57,000 people in the United States died because they were not receiving appropriate health care—in most cases, because common medical conditions such as high blood pressure or elevated cholesterol are not adequately controlled (National Committee for Quality Assurance, 2010). Hospitals vary greatly in their risk-adjusted mortality rates for Medicare patients; during 2009 to 2012, risk-adjusted deaths from heart failure and pneumonia were three times higher for lower-quality compared with higher-quality hospitals (Medicare Hospital Quality Chartbook, 2013). A previous study showed that if low-quality hospitals reduced mortality rates to the level of high-quality hospitals, 17,000 to 21,000 fewer deaths per year would have occurred (Schoen et al., 2006).

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Fatal medication errors among outpatients doubled between 1983 and 1993 (Phillips et al., 1998). Prescribing errors occur in 7.6% of outpatient prescriptions (Gandhi et al., 2005), which amounts to 228 million errors in 2004. In 2007, about 25% of elderly patients received high-risk medications (Zhang et al., 2010). Diagnostic error rates are around 10% for a variety of medical conditions (Wachter, 2010). In some primary care practices, patients are not informed about abnormal laboratory results more than 20% of the time (Casalino et al., 2009).

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Two million lives would have been saved in 2006 if preventive services had been regularly delivered to the entire population (Maciosek et al., 2010). Only 50% of people with hypertension are adequately treated (Egan, 2010) and 43% of people with diabetes are inadequately controlled (Cheung et al., 2009). Racial and ethnic minority patients experience an inferior quality of care compared with white patients (Agency for Healthcare Research and Quality, 2015).

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A recent article (Chassin and Loeb, 2011) summarized that “Health care quality and safety today are best characterized as showing pockets of excellence on specific measures or in particular services at individual health care facilities … The pockets of excellence mentioned above coexist with enormously variable performance across the delivery system. Along with some progress, we are experiencing ...

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