Quality of care and its impact on population health: a cross-sectional study from Macedonia.

Research has revealed significant variation in both the quality of clinical care and the health status of populations. We conducted a study to determine if variations in the quality of clinical care can be quantitatively linked to variations in health status, at the patient and the population level. This study, conducted at health facilities in four municipalities in Macedonia, collected cross-sectional data on (1) structural measures (such as infrastructure, facilities, equipment and costs) and the quality of clinical care provided by physicians (as measured by clinical vignettes); (2) detailed health and socioeconomic status information on patients using the facilities; and (3) nearly the same information on a random sample of adults in each municipality. Data were collected from a total of 57 facilities, 273 physicians, 1451 patients, and 1627 adults from the general population. The main outcome measure was health status, based on self-reported health surveys. Objective health measures were obtained to control for preexisting conditions. The main explanatory variable was quality of clinical care, based on physicians' clinical vignette scores. Structural measures were included in our model but had a more distal relationship to health status. We found that quality of care strongly predicted self-reported health status of patients using the facilities even after controlling for other factors (p < .05). Quality of care was also associated with higher health status for the population living in the surrounding community, regardless of utilization (p < .05). This linkage between quality of clinical care and health suggests that policies that improve clinical practice have the potential to improve population health more rapidly than other interventions.