TUESDAY, May 4, 2004 (HealthDayNews) -- Where are you guaranteed first-rate medical care -- a local hospital or a highly regarded teaching hospital?
Neither, says a new Rand Corp. study that found that even at the nation's top hospitals, the quality of care falls short of recommended standards.
In 12 metropolitan areas that were reviewed, the researchers found similar levels of performance and treatment, with important deficits in basic care for acute and chronic conditions.
"The overall finding is that, on average, people in each community got only about 50 to 60 percent of recommended care," said Dr. Eve A. Kerr, a researcher with the Veterans Affairs Ann Arbor Health Care System and an assistant professor of internal medicine at the University of Michigan.
"That means no matter where you live, you are at risk for poor care, even if you live in communities with some of the best teaching hospitals in the country," she said.
"This study should serve as a wake-up call for all communities to evaluate and improve their quality of care," Kerr added.
The study appears in the May/June issue of Health Affairs.
Meanwhile, a new international comparison of health-care quality shows U.S. health care isn't the best in the world. While the United States far outspends other English-speaking countries on health care, it doesn't seem to be getting any better value for its dollars, according to the study released May 4.
Done by the Commonwealth Fund and also appearing in May/June issue of Health Affairs, the review compared 21 key quality areas for the United States, Canada, Australia, New Zealand and England.
The United States, which spent $4,887 per capita on health care in 2001 -- twice as much as its closest rival, Canada -- had the best five-year survival rates for breast cancer, but the worst five-year survival rates for kidney transplants. And while cervical cancer screening rates in the United States were very high, the United States was the only one of the five countries that showed asthma mortality rates on the rise.
According to Kerr, the Rand researchers evaluating U.S. hospitals interviewed nearly 7,000 people in the 12 metro areas, and also looked at all of their medical records.
"In these records, we looked at the care for 30 common acute and chronic conditions that are the leading causes of death and disability," Kerr said.
Some of the conditions were asthma, certain cancers, diabetes, heart disease and high blood pressure.
"These are conditions that we know how to treat, where we know what works, and we can assess if what works was actually done," Kerr said.
The areas studied were Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; Newark, N.J.; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
In these communities, there were no significant differences in the quality of health care. The amount of recommended services actually received was remarkably similar in each community, Kerr said.
However, care did vary by condition, with diabetes receiving the poorest care. Only 40 percent to 55 percent of recommended services for diabetes were provided across all 12 communities, the researchers found.
Lead researcher Elizabeth A. McGlynn, associate director of Rand Health, said the researchers thought they would find substantial differences in the quality of care among communities.
However, despite large differences in the health-care infrastructure in each area, "we found that the care people were getting was about the same," she said. "Even in the best-performing city, Seattle, people failed to get care they needed about 40 percent of the time."
"Failing to get the care we need means that we have thousands of needless deaths each year," she added.
Communities need to do three things to improve the quality of health care, said co-researcher Dr. Steven M. Asch, from the Veterans Affairs Greater Los Angeles Health Care System and Rand Health.
First, "communities have to monitor their own performance, because you can't fix it if you don't know about it," he said. Second, "communities have to work together to effect change. The third thing is to improve the information that doctors and patients have when they need it."
Asch said electronic medical records should go a long way to improving information flow. "In my practice, electronic medical records remind me and my patients of strategies that we might have otherwise missed -- anything from flu shots to the right drugs," he said.
Concerning the validity of the study, Asch said, "This is a guess, but it is the best guess we have ever had as to what the quality of care in the U.S. and in these 12 communities looks like. But this best guess tells us we have problems we have to work on."
To check that these findings reflect conditions throughout the United States, the researchers said they'd like to expand their study to 100 cities, but they suspect the results would be the same.
"The way I look at it is, ask not what your health system can do for you, but ask what you can do for your health system," Asch said. "We all have a responsibility to improve care. That's employers, that's doctors, that's patients, that's everybody who has a stake in the health system -- and that's everyone."
Elizabeth H. Bradley, an associate professor of epidemiology and public health at Yale University, said the new findings "are compelling, especially when put in the context of several other relatively recent reports documenting that actual care falls short of guideline-based care."
Bradley believes "we should focus on those areas where quality is highest and understand what it is they are doing that can be replicated elsewhere."
"We need to focus on what some communities have done right and how that might provide insight on how other communities can take advantage of opportunities to improve, rather than shake our heads in disgust at the poorer-performing communities," she said.
In addition, Bradley said, patient "involvement and understanding in the care process can help to ensure the treatment plan is shared, risks and benefits are understood, and decisions are consonant with patient and family wishes. Hard to effect, but nonetheless critical to high quality care."
More information
The Agency for Healthcare Research and Quality can tell you more about quality health care. The National Committee for Quality Assurance can tell you more about rating health plans.
