LANDMARK
STUDY FINDS ADULTS FAIL TO GET RECOMMENDED CARE
The largest and most comprehensive examination
of health care quality in the US finds people with
diabetes received only 45 percent of the care they
need.
A new RAND Health study that is the largest and
most comprehensive examination ever conducted
of health care quality in the United States found
that adults fail to receive recommended health
care nearly half the time.
Researchers noted that the deficiencies in care
they found pose “serious threats to the
health of the American public” that could
contribute to thousands of preventable deaths
in the United States each year.
The researchers said their findings shatter the
widely held perception that health care quality
is not a problem in the United States. In reality,
the study found that many people are not receiving
appropriate treatment. According to the researchers,
these findings are the best estimates ever provided
of the seriousness of the quality problem in the
United States.
The study – which examined preventive care
as well as the management of 30 common health
problems such as diabetes, asthma, high blood
pressure and heart disease – is to be published
Thursday (June 25) in the New England Journal
of Medicine.
“Most of us take health care quality for
granted,” said lead study author Elizabeth
A. McGlynn, Ph.D., Associate Director of RAND
Health. “This study shows that we can’t.
There is a tremendous gap between what we know
works and what patients are actually getting.
Virtually everyone in this country is at risk
for poor care.”
The study used a unique methodology that involved
both random telephone surveys and reviews of patients’
medical records. Nearly 7,000 adults in 12 metropolitan
areas were interviewed about selected health care
experiences. In addition, those interviewed gave
written consent for researchers to review their
medical records and use the information to evaluate
performance on 439 detailed clinical indicators
of care for 30 acute and chronic conditions*,
as well as preventive care.
“For the nation to make serious progress
on quality, we must have routinely available,
at every level in the health care system, the
type of information produced for this study,”
noted David Lawrence, M.D., retired Chairman and
CEO of Kaiser Foundation Health Plan and Hospitals.
“The methods developed at RAND represent
the gold standard for future assessments of health
care quality.”
Most other studies have assessed a single condition,
focused on a small number of indicators of quality,
looked at care in one geographic area, or assessed
people with a single type of insurance coverage.
This study looks at how health care across the
nation is being provided and cuts across all geographic
areas, insurance types and a wide range of conditions.
Quality varied substantially according to medical
condition, ranging from 79 percent of recommended
care for cataracts among older people to 11 percent
of recommended care for people with alcohol dependence.
Among the key findings:
? People with diabetes received only 45 percent
of the care they need. For example, less than
one-quarter of diabetics had their blood sugar
levels measured regularly. Poor control of blood
sugar can lead to kidney failure, blindness and
amputation of limbs.
? People with coronary artery disease received
68 percent of recommended care, but just 45 percent
of heart attack patients received medications
that could reduce their risk of death by more
that 20 percent.
? Patients with pneumonia received just 39 percent
of recommended care. In fact, fewer than two-thirds
of elderly Americans were vaccinated against pneumonia.
Nearly 10,000 deaths from pneumonia could be prevented
annually through proper vaccinations.
? Patients with colorectal cancer received 54
percent of recommended care, but just 38 percent
of adults were screened for colorectal cancer.
Routine tests and appropriate follow-up could
prevent 9,600 deaths a year.
? Patients with high blood pressure received
less than 65 percent of recommended care. Poor
blood pressure control is associated with increased
risk for heart disease, stroke and death. In fact,
poor blood pressure control contributes to more
than 68,000 preventable deaths annually.
Similar levels of deficiencies were found across
preventive, acute, and chronic care. Underuse
of care was greater than overuse. Patients failed
to receive recommended care approximately 46 percent
of the time, compared with 11 percent of the time
when they received care that was not recommended
and potentially harmful. Overall, patients received
55 percent of recommended care.
“Even people who had health insurance and
access to health care services failed to receive
some elements of good care,” McGlynn said.
“This suggests that just being able to get
in the door to see a doctor is no guarantee that
you’ll receive the care you need.”
McGlynn and her colleagues noted that these deficiencies
appeared despite concerted efforts in recent years
by both the federal government and the private
sector to improve health care delivery. The researchers
said that key to any future progress will be the
routine availability of information on health
care performance at all levels.
“Making such information available will
require a major overhaul of our current health
information systems, with a focus on automating
the entry and retrieval of key data for clinical
decision making and for the measurement and reporting
of quality,” the researchers wrote.
The study was funded by The Robert Wood Johnson
Foundation (RWJF).
RAND Health is the nation's largest independent
health-policy research organization, with a broad
research portfolio that focuses on medical quality,
health-care costs and delivery of health care,
among other topics.
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