Patients' care often deficient, study says
Proper treatment given half the time
By Rita Rubin, USA TODAY
 

On average, doctors provide appropriate health care only about half the time, a landmark study of adults in 12 U.S. metropolitan areas suggests.

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 say their work is the largest and most comprehensive examination of the quality of health care in the USA. 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 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. For preventive care, researchers examined 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 that 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."

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