WEDNESDAY, Feb. 28, 2007 (HealthDay News) -- U.S. government efforts to improve care for medically underserved populations have met with some success, an ambitious new study finds.
The analysis of 44 community health centers found gains in disease prevention, screening and treatment for patients with diabetes and asthma but not for patients with hypertension.
"We were looking for evidence of effectiveness of quality improvement, and this provides evidence that these types of techniques can certainly yield at least moderate improvements for these important chronic medical conditions," said study author Dr. Bruce Landon, an associate professor of health-care policy and medicine at Harvard Medical School.
The interventions did not result in benefits in clinical outcomes for patients, however, Landon's team reports in the March 1 issue of the New England Journal of Medicine.
The Health Disparities Collaboratives, sponsored by the government's Health Resources and Services Administration (HRSA), were designed to improve health care in community health centers, which often cater to underserved populations, including racial and ethnic minorities and uninsured patients.
The centers, which provide care for more than 15 million Americans, are intended to reduce disparities in health-care quality.
The program brings together community health centers to learn and disseminate quality-improvement techniques developed by the Institute for Healthcare Improvement.
As each health center tests and implements small-scale interventions, new practices and procedures are adopted.
This study looked at interventions to improve care at community health centers for individuals with diabetes, asthma or hypertension, chronic diseases which, together, affect more than one-quarter of the U.S. adult population.
The researchers tracked outcomes for 9,658 patients at 44 community health centers participating in the Health Disparities Collaboratives and 20 centers not participating in the program, for comparison. Each center served as an internal control for another condition.
Overall, the centers affected by the intervention showed more improvement in prevention, screening and treatment measures than either the external or internal controls for quality of care for patients with asthma and diabetes, but not hypertension.
There was a 21 percent increase in foot examinations for patients with diabetes in centers participating in the program, a 14 percent increase in the use of anti-inflammatory drugs for asthma, and a 16 percent increase in testing for blood glucose.
There was no improvement in "intermediate outcomes," however -- clinical markers such as the need for urgent care or hospitalization for asthma, or the control of blood pressure for hypertension.
"These things can be effective, but sometimes they don't work and the reasons they don't work are not always clear," Landon said.
While praising the study, Dr. Rodney Hayward, author of an accompanying editorial, pointed to bigger problems with evaluating quality of health care in this country.
"The study shows us how hard it is to achieve real high levels on some of these quality measures," said Hayward, who is director of health services research and development at the VA Ann Arbor Healthcare System and a professor of medicine and public health at the University of Michigan. "We have to better understand some of the reasons we're not at the level we wish to be."
While some point to problems with health-care quality (for example, the doctor is responsible for patients not taking their blood pressure medication), others point to consumer/patient issues (they're ultimately responsible for taking their medication correctly).
"Some measures are not necessarily a perfect reflection of quality. They're not even close to perfect," Hayward said. "If we adjust payments [to reflect those measures], we can really do some unfair things that might harm the patients that need the most attention."
But the current processes for determining issues such as quality measures are highly political, Hayward said. "The science and the evidence often get left out," he said. "My personal belief is that this will not improve until we have independent groups that evaluate and give information based on the best medical evidence and what is best for the public. Right now, we don't have any such process."
More information
There's more on the Health Disparities Collaboratives at the HRSA.
