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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. Many patients’ interactions with the health care system fall short (Institute of Medicine, 1999, 2001). As of 2018, quality was improving slowly overall in the United States but lagging in some regions of the country; moreover, serious disparities exist, harming minority and low-income populations (US Department of Health and Human Services, 2018).

A 2016 study estimated that over 250,000 people each year die as a result of preventable medical errors in hospitals, meaning that medical errors are the third leading cause of death in the United States (Makary & Daniel, 2016). Every year, 1 out of every 25 patients develops an infection while in the hospital—an infection that did not have to happen. A Medicare patient has a 1 in 4 chance of experiencing injury, harm, or death when admitted to a hospital (The Leapfrog Group, 2018).

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).

Ambulatory care also has quality problems. A 2003 study found that adults in the United States received just over half of recommended health services (McGlynn et al., 2003). A 2016 follow-up concluded, “Despite more than a decade of efforts, the clinical quality of outpatient care delivered to American adults has not consistently improved” (Levine et al., 2016). Preventable medication errors are estimated to impact more than 7 million patients, contribute to 7,000 deaths, and cost almost $21 billion in direct medical costs (Lahue et al., 2012). In some primary care practices, patients are not informed about abnormal laboratory results more than 20% of the time (Casalino et al., 2009).

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 53% of people with hypertension are adequately treated (Yoon et al., 2015) and only 14% of people with diabetes meet their targets for glycemic, blood pressure, and cholesterol control (American Diabetes Association, 2019). Racial and ethnic minority patients experience an inferior quality of care compared with white patients (US Department of Health and Human Services, 2018).

Chassin and Loeb (2011) summarized, “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 ...

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