Thursday, April 15, 2010

Health Care Quality Stats

The Agency for Healthcare Research and Quality has just released its 2009 report on health care. This is worth the read. The trends reflect the limited improvements in the system. It is a reflective report and does not really look forward.

They state:

Despite the data limitations, we find that health care quality in America is suboptimal. The gap between best possible care and that which is routinely delivered remains substantial across the Nation. Receipt of quality health care also varies widely. For example, caregivers reported that 95% of hospice patients received the right amount of pain medication, but only 8% of patients needing care for alcohol problems received such treatment at a specialty facility. Across the core report measures tracked in the NHQR, the median level of receipt of needed services was 58%. We can and should do better.

Moreover, despite efforts to transform the U.S. health care system to focus on effective preventive and chronic illness care, it continues to perform better when delivering diagnostic and therapeutic care in response to acute medical problems. Our system achieves higher performance on hospital measures, such as acute treatment for heart attacks, than on outpatient measures, such as cancer screening and diabetes management. For example, between the 2008 and 2009 reports, five measures attained overall performance levels exceeding 95%.ii Four of these five measures relate to hospital care for heart attack. In addition, all 10 of the worst performing process measures tracked in this NHQR are measures of outpatient care, and 6 of these relate to preventive services.

One of the concerns is that much of the concern about prevention is truly a patient duty and we continue to disconnect the patient from the outcome. Patients who smoke, who are obese, who fail to get the proper tests especially if family history tells them they should are as much to blame as is the system. A physician can only deal with a patient and their propensity to get ill if the patient shows up and then follow through.