Quality of care: Less impressive than most Americans think

A study of health care provided in 12 metropolitan areas across the country shows that patients receive what guidelines consider appropriate treatment and preventive care only about half the time. The research, funded by the Robert Wood Johnson Foundation, examined interviews and medical records from 6,700 people in Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; Newark, N.J.; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Researchers were looking for the presence of recommended treatments for 30 conditions (hypertension, asthma, breast cancer, and depression, for example) as well as such standard preventive measures as immunization against pneumococcal infection in elderly patients and blood sugar measurement among diabetics. According to Elizabeth A. McGlynn of the RAND corporation, lead author of the study, such inadequate care leads to "thousands of needless deaths each year."

A second study, financed by the Commonwealth Fund and led by Peter Hussey, a doctoral candidate at the Bloomberg School of Public Health of Johns Hopkins University, compared quality of care in the United States with that of Australia, Canada, England, and New Zealand. The United States spends twice as much per person on health care as the other countries, the study found, but the overall quality of care that those US expenditures purchase—measured by 21 indicators, such as cancer survival and infectious disease rates—is not twice as high. In fact, no single country surveyed was best or worst overall. The United States scored highest for the five-year breast cancer survival rate and cervical cancer screening, and had the lowest incidence of measles and the lowest smoking rate (a tie with Canada), but had the worst five-year survival rate for kidney transplantation and the highest incidence of hepatitis B infection and was the only country of the five with a rising death rate from asthma. Both studies were published in the May/June 2004 issue of Health Affairs and can be read at www.healthaffairs.org .

The matter of quality in health care was recently addressed by the American College of Physicians in articles that advocate, first, performance measurements to improve physicians' quality of care and, second, development of a national health information infrastructure to support those quality improvements. The full text of both articles is at www.acponline.org