On
average, doctors provide appropriate health care only about
half the time, suggests a landmark study of adults in 12 U.S.
metropolitan areas.
Such
deficiencies "pose serious threats to the health of the American
public" that lead to tens of thousands of preventable deaths
each year, researchers report in today's New England Journal
of Medicine.
The authors call their work the largest and most comprehensive
examination of U.S. health care quality. Though the study
stopped short of linking inappropriate care to the poor health
or death of individual patients, it shows that Americans cannot
take for granted that they're getting good care, says lead
author Elizabeth McGlynn, associate director of RAND Health.
The study involved 7,528 adults who participated in a telephone
interview about their health history and provided access to
their medical records.
Researchers used the medical records to assess care for 30
common conditions as well as preventive care. They based their
evaluation on 439 indicators of quality gleaned from established
national guidelines and medical literature. For example, if
patients had high blood pressure, researchers checked whether
their doctors had changed their medication to better control
blood pressure if needed. For preventive care, researchers
looked at factors such as cancer screening and flu shots for
the elderly.
Overall, patients' medical charts showed that doctors provided
55% of appropriate care. On average, that proportion varied
little among the chronic, acute or preventive care categories.
McGlynn acknowledges it's possible that doctors didn't write
everything down in patients' charts. But that in itself represents
poor-quality care, she says. "How can they proactively follow
up on something if they don't have a note on the chart?"
The key to improving health care quality would be to provide
performance data on all U.S. doctors, McGlynn says. Such a
step would require "a major overhaul of our current health
information systems," she and her colleagues write.
Carolyn Clancy, director of the Agency for Health Quality
and Research, says Health and Human Services Secretary Tommy
Thompson is eager to switch to a more efficient paperless
health care system.
In an accompanying editorial, Earl Steinberg writes that it's
"ludicrous" to expect physicians to keep up with hundreds
of practice guidelines without a computerized system. "I reliably
receive reminders when my dog needs a vaccination," writes
Steinberg, of Johns Hopkins University. "Physicians and patients
should also receive computer-driven reminders."
Karen Ignagni, president of the American Association of Health
Plans, commended the study in a statement: "We couldn't agree
more that consumers in America's health care system face a
dangerous disconnect between what the best medical science
recommends and the treatment they often receive."
Such
deficiencies "pose serious threats to the health of the American
public" that lead to tens of thousands of preventable deaths
each year, researchers report in today's New England Journal
of Medicine.
