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Quality medical care lacking 45 percent of the time, study finds

WASHINGTON—U.S. patients receive proper medical care from doctors and nurses only 55 percent of the time, regardless of their race, income, education or insurance status, according to a national study published Thursday in The New England Journal of Medicine.

A well-functioning health care system should provide recommended levels of care 80 to 90 percent of the time, the study's authors said.

In a performance review of preventive services and care for 30 chronic conditions, including hypertension, diabetes and heart disease, researchers found that it's almost a coin flip as to whether patients get the recommended care from doctors and nurses—even though the standard treatments are widely known.

The findings show that everyone is at roughly equal risk of inadequate care from medical professionals. However, small differences did occur in the care given male and female patients and those from different racial and ethnic groups.

"Not only is no place safe, no one is safe from poor quality," said Dr. Steven M. Asch, the lead author and senior natural scientist at Los Angeles-based RAND Health, the nation's largest independent health-policy research organization. "No matter what group we looked at, whether they were black, white, rich or poor, uninsured, insured, educated, uneducated, all of them were receiving mediocre care."

He blamed the nation's "fragmented and chaotic" health care system for making it difficult to deliver quality care. Greater use of computers could improve care by helping doctors track patients' medical histories, he said. In addition, computers could provide electronic reminders about needed tests and appointments. Electronic medical records could log information on other caregivers' thoughts about a patient's condition.

The Department of Veterans Affairs has incorporated some of these improvements, and a study has found that VA patients get proper recommended care about 66 percent of the time.

The RAND study, funded by The Robert Wood Johnson Foundation, used telephone surveys and patient medical records to follow the health care of nearly 7,000 adults in 12 metropolitan areas.

The study found that:

_Women got a higher level of recommended care than men—57 percent vs. 52 percent.

_Younger and more affluent patients were more likely to be screened, but less likely to get follow-up treatment, than older patients.

_Patients with family incomes of more than $50,000 had quality care scores just 3.5 percentage points higher than those with incomes of less than $15,000.

In addition, the study found that blacks and Hispanics were slightly more likely to get proper levels of care than whites, but only by about 3.5 percentage points.

Those findings don't counter previous studies that found wide disparities in access to health care for minorities and low-income people. In fact, Asch said, those disparities are a "serious, well-documented problem," particularly when it comes to complicated surgical procedures.

"But for common conditions, we found that once you're in the door, there's little difference in what physicians recommend. Everyone gets recommended care just half the time," he said.

Ron Pollack, executive director of Families USA, a national patient advocacy group, was surprised by the findings and said he didn't believe that a patient's financial resources and insurance status had no effect on the quality of care he or she receives.

"It may be we need to improve for everybody the quality of health care, but it certainly is very evident that these people with inadequate insurance or the uninsured are far more vulnerable to low-quality care or lousy care than others," Pollack said.

The American Medical Association didn't comment on the RAND study. But in an effort to standardize quality care, the AMA's Physician Consortium for Performance Improvement has developed for doctors 90 performance measures covering 15 conditions. By the end of 2006, the consortium hopes to have 140 measures covering 34 clinical areas.


(c) 2006, Knight Ridder/Tribune Information Services.

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