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Agency for Healthcare Research Quality

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Clinical Measures

Clinical measures can be used to assess quality of care and patient satisfaction. Examples are provided here of measures that can be used to assess care quality for three of the most common conditions: diabetes, heart disease, and cancer.


More than 6 percent of all Americans have diabetes. Diabetes is the leading cause of blindness, leg amputation not resulting from trauma, and kidney disease. Diabetes increases the risk of complications in pregnant women, and it is a risk factor for heart disease and stroke. People who have diabetes are two to four times as likely to die from heart disease or stroke as those without diabetes.

The following five measures can be used to assess quality of care for diabetes. If you have diabetes, you should receive the following tests and exams:

  • Regular hemoglobin A1c (blood glucose) testing.
  • Regular cholesterol testing.
  • Annual retinal eye exam.
  • Annual foot exam.
  • Flu shot each year.

Heart Disease

Heart disease—or cardiovascular disease—is a collection of diseases of the heart and blood vessels that includes heart attack, stroke, and heart failure. About 64 million Americans are living with heart disease.

Heart disease is the number one cause of death in the United States. Maintaining control of blood pressure and cholesterol can help you prevent heart attack and stroke.

The following are examples of measures that can be used to assess care for heart disease.

For adults age 18 and older:

  • Blood pressure measurement.
  • Cholesterol testing.

In general:

  • If you smoke, being advised to stop smoking.
  • If you suffer a heart attack, receiving aspirin within 24 hours of hospital admission and being prescribed beta-blocker therapy at hospital discharge.

John's Story

John awoke from a restless night's sleep with a feeling of tightness in his chest and pain down his left arm. John was having a heart attack. His wife called 911, and he was taken to the emergency room via ambulance.

The ER doctors took very good care of John. He was given an aspirin almost as soon as he arrived at the hospital.

Fortunately, John's heart attack was mild. After undergoing some special tests, his heart surgeon implanted a stent to prop open his partially clogged artery.

As John was being discharged from the hospital, his doctor prescribed beta-blocker therapy to reduce the risk that he would have another heart attack. John was advised to have his blood pressure and cholesterol checked regularly. John got the right care for his heart attack.

More than 60 million men and women are living with heart disease. Everyone should know what constitutes good quality care for heart disease.


Cancer is the Nation's second leading cause of death, after heart disease. Each year, more than 1 million new cases of cancer are diagnosed. Four cancers account for over half of the new cases reported each year. The four cancers are: lung, colorectal, breast, and prostate.

Screening to permit early detection holds the most promise for successful cancer treatment.

Talk to your doctor about screening tests for all of these cancers, especially if other members of your family have had these cancers or if you smoke.

The following are examples of quality measures for several types of cancer screening.

Breast and cervical cancer:

  • Mammography exam for women age 40 and older.
  • Pap smear testing for women age 18 and older.

Colorectal cancer: Men and women age 50 and older should receive the following tests:

  • Fecal occult blood testing (a test to detect blood in the stool).
  • Flexible sigmoidoscopy/colonoscopy exam. Check with your doctor about how often you should have this screening.

Jean's Story

Jean was 45 when she went to her doctor for a checkup 5 years ago. Her doctor performed a clinical breast exam and found nothing remarkable. Jean was given a referral to a nearby x-ray facility to have a mammogram.

A week or so later, Jean received a phone call from her doctor's office asking her to come in to go over the results. The mammogram showed a small lump in Jean's right breast. Her doctor referred her to a breast surgeon for a biopsy. The biopsy revealed early-stage breast cancer. Jean had a lumpectomy and followup radiation.

Today, Jean is cancer-free and looking forward to the birth of her first grandchild. Getting the right care—a mammogram—at the right time—over 40 years of age—saved Jean's life. For Jean, getting quality health care gave her a new lease on life.

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