Quality of Health Care in the U.S.

• 6712 patients from 12 metropolitan areas• Medical record review (2 yrs) + interview• 30 acute/chronic conditions, preventive care

• 439 indicators for screening, dx, rx & f/u care

• Results: patients received ~55% recommended care

• Conclusion:“The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public.”

McGlynn, NEJM 2003;348:2635-45

Systematic Review: The Relationship between Clinical Experience and Quality of Health Care*

• Systematic review of 62 reports• 4 categories of reports:

• Medical knowledge• Adherence to standards of care for

diagnosis, screening, or prevention• Adherence to standards of care for

therapy• Health outcomes

• 6 result categories: consistently negative, partially negative, no effect, mixed effect, partially positive, consistently positive*Choudhry, Ann Intern Med 2005;142:260-273.

Overall Results for 62 Reports

0

5

10

15

20

25

30

35

ConsistentlyNegative

Mixed PartiallyPositive

Overall

Results for Medical Knowledge

• All 12 showed consistently negative results

• Knowledge measured:• General knowledge (4)• HIV care (3)• Hypertension, MI, emergency

contraception, lung cancer and blood product transfusion (1 each)

Adherence to Standards for Screening, Diagnosis & Preventive Health Care

01

2

3

4

5

6

78

9

10

ConsistentlyNegative

NoAssociation

Standards for Dx,Screening andPrevention (n=24)

Adherence to Standards for Appropriate Use of Therapy

0

1

2

3

4

5

6

7

8

ConsistentlyNegative

Mixed PartiallyPositive

Adherence to Standardsfor Therapy (n=19)

Relationship to Health Outcomes

0

0.5

1

1.5

2

2.5

3

ConsistentlyNegative

Mixed PartiallyPositive

Health Outcomes(n=7)