DTIC ADA427447: The First National Report Card on Quality of Health Care in America

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The First National Report Card on
Quality of Health Care in America

‘ov ged the qualey oF held care
jn Areriex? To anewer this querion,
Fliabech Matlyma Jed a 2am of

exper ithe largess al owt com
ot
lad

prchensive exaraaarion ever cond
eal cate quale in the Ui Sse.
‘he Cannaunicy Quality Ink Sel,
auceeed che extent 0 which reeorneenbd cate
‘yrs provided tr a reptescouaie sale of he
US. poymzion fora broad zange of condi-
‘ons in 12 metropabcea aces

Designing @ Netonal Rapart Card on
‘Quality of Care

‘Tas Cannanuniey Chalice Inder Sead dics
fon previous aesmants of quay bexaose
evar more comprehensive, exenined paity
cous the wation rather than in one googlaphic
are and ieeladed peeple wid all pps of
iiwuranee al a wide ange of conditions. The
research team used candon mephone surveys
ts iueview miore chan 13.000 agus in (2
‘nceopoitan arse mgpeding ther health sare
expestencs (se Figure 1) About 6,700 isle
ual provided written cant fr maureen
teview dhelr medical revs aa we bene
smacion ro evloate pefonmam: on 439 clsieal
incarors of uslty for 30 ee al chore

Koy Findings:

+ Overall dal eave ahour half of

recommeded

Ta el of piforrance war sar for

won, are, end prove eae.

iyo or vr oa
condition

ally by

+ Perfo es alo siler in each of
Fhe open rear ude

+ No crusty had omit th st

cmlisions, sh 28 dibexss ellis, ascbma,
Snyperrasan (high bland pressure), and hear.
fice. al for cai preventive care

Measuring Quality of Care
"Yo define and measure quali, the texm tel:
‘ged a ser of quay adios, knee 38 the
RAND Qualy Amessmene (QA Tools tem
RAND suf elered 30 dnial eas apr
ing the leading causes of dent ant dnbilty9¢

This Highlight summoriaes RAND reseutch reported in he Fllawing pablicaonst

pan EA, Ac SM, Ala J Kay J Hi J, Denon Ac ard Ker HA, "The ay oF
ivelih Care Dedede fn Bc Ul Sanea" Now Enh al of ane Va 3H. No.6,
Ione 26,2003, pp. 2695 2515

Ker i Meloy BA. Ads | Kasey] and A SM, "Paling he Qty of Carn Comrie:
5 Bean he Convince Smad Heb in VU 23, N03 Wylie 200%. pp

5%
DISTRIBUTION STATENET
‘Approved for Public Fielaas
‘Distibution Unlimited
‘Glnvced Conditions Included in the
RAND Quality Assessment Tools System
‘Alohal dependance

Atha

‘Arial fibeilaon

Benign prosttic hyper plesics

Broce cancer

Gaveer pein ae pation

Cores

Corabrovoscular disease

Cesare delve

Chronic absucive pulmonary dase
oor ene

Community acquired premani

‘Coronary artery cvense

Depression

Dicbetes mle

Dyapepsa and peptic weer disease

Headache

Heart bare
his ara

a

Hyperomion

Hysterectomy

Low beck pin coe

Menopav'e manegoren

Orhopede condions

neces

Froth cere

Prox concer

Usa ra infection

agin ond scaly ron cieoves

Excimples of Related Preventive Care

roost canon screening
Cervical egnesr serening
Golractol cancer searing
Grate we counseling
Family planning/conttaception
Ienniztions

Sereering for problem drinking

Figure 1
(Mieerpolitan Arar in the Cormmeaity Quatly Inox
Study

eRe

arama

acd
Cote Paden

sella he major reson that pope yok ere. They dv
copes specific antans or ality inicaons within zc clin-
fea aes have on revo national guidlines andthe
redial lieeture. ancl of experts eae dhe proposed
‘dale ndizaors, (All eke qual indicators, including che
Frortuze resiewed and dhe panel recommendations av: ai
Able co the RAND Heslth website ar wwncrand angel
sook/qualis ht) The researchers devchped computes

fea vetoed sntetion sftware wo feared
tlt by ne

“The rzerchersconcructed a quay “tore for ech
‘of tres tha he patie

ssid

potent, ‘The seve wae the nu

sseived the care trammmendadaeraull of he cndiions

shat she patient in 4 tury pind divided by the
at deveined vo ocd

nde of duns da the pt
spi heal ee icerenons, The ream chen aggregated
tho iis idol scores to obtain qualey oom for various
Siunensnors of performance

‘Study High

* Overall, paricpants in tes Muy eveived 95 poms of

revemmendd ss

+ Grideruse of ete was a geewer problen than overuse, For
example, pation Called to eeecive commented cae
boat 46 pexcent of che dime, compred th 21 percent of
etme when dey rccied care chaz as nos recommend
sed and potemilly safle Tigre 2,

+ Overall pesformance was singly similar te all of the
scanvanii studied. Overs quay renge fram $9 pee
‘em iv Seals tg 51 petcuo: in Lele Rock le Fgue 3)
‘he varehess found the sume basic Lvl of pevfoemance
fin scm, use, ad poevensve ce
+ Cuulicy vied enbetantilly arc crsdons, For example
people with cares exivalahnee 79 pexenc of recom
ended cane; pets with alosl dependence recived
bout 1 pret (we Fp).

+ Preven care, All vonumuniies id a bere job of pre

gente fog, eae

sing blood prs) and isumunizaions compared with

ening choot ie aongh Ste

locket pes of panting ciks—far example, prevention of
sesully transmitted sees and LDV and couneding for
substan se
+ Care fr chninie disse. Care forsee eee conde
tiv (ante ene, depron, hypertension, dishes, and
elim ary problems) vied both tems eutaiions and
es comnaniie within de sae evn. Hot example
= Quay of cae for hypernasivm wa stnong the best for
he chronic condone resides in Cleveland seetved
shout 70 percent of moma cate fortis condition,
= Quilty of ee fr cave eneitiona Gneluding com
ary avery dene, congesive heart faire, and ace!
‘bilatnn) wae generally lore than care for hyperte
si, tang fom $2 pencen in Teanaputicand

‘Orange County 1 70 pecent in Cleveland and Syracose,

= Quelity of rare pln Jouboros fama ana
chronic ubsnasive pusonasy dive) war lower thom
tne fir hypernson of cada conditions.

= Care for depression was even foe, raping foun 47
percene in Newark «63 percent i Sete

= Trt erst, quley of cate For dibetes wo
Suortshan ene Far depression.

[No single community bad conse the hight lowest
posfomance fr al af the due onion "Uhe late cake
Ig of he commerivos change depending on the aspect of
co: cing exrinal. (Sce quai stings toe each comming
av hupefooeand orgfacinlpree 045 frable pl)

oss Poor Quality Matter?

“The dace in cae decumend nthe Carmimanity Qualcy

Index Study pose scious hzets eth hea ofthe Amevi-

can public and trance invo thous of preventable com-

‘rations and deaths per year (se tu teow page

+ People ith diabetes cecved only 45 pers ofthe care
they needed, For example, less chin one-peator af diaboe-

ier bad die average blood sage level cased pula
Poor connolef blood saga can lel lily So,
blindness, and amputation of limbs

+ Hovenes with hypersensionceceved lees than 65 pes
‘fF recommended cae, Por blood presine voatel i 0-
cata wis nascin fr bere dee stoke, and.

Performance of the U.S. Health Care System

Studied
stad
ig
Foe
orange cout
‘ie Roe

‘ane
peso

Aleta

Paudige of ead ee

‘Quality vf Carn We Siar In All the Communities
death. it, poos blood presttecontel contributes
‘ure than 68,000 prevenakle deaths aly,

+ Pasple with coronary artery dtcae mevived 68 percent
of secommended cate, bu just 45 pervant of heart aac
patient erred era locke and 61 pera go spin
veiitions that could seduce thet sg of death by mone
than 20 pert

+ Patent with pneumonia rosved just 39 percene of rc-
‘unmended az, Infact, fewer than to hin of elderly
Amicancwenevaccinaed against precmonia, Neale
10,000 deals oes pocumenia could be prevented anna
ally sheugh popecsaccinations.

+ Pasons with eclovectat cancer recived 5 percent of
ecommael cae, bur use 38 pecene of ada were
screen fr ealorecal cancer Rowrine tems and appro-
pat follow-up could prevent 9,601 deaths a yea,

What's Needed to hnprova Care?
‘This sid provides the best estimates ever nehbe abour
he quali of ewe in che United States, The stody eels
sobstantal gas berween whar clinicians knew works and the
cae atally provide. Thee defies pete deat nti
tse by bods che federal goverment and private hes eae
delivery ayers to improve care

‘This sadly noe te Bsc deny pone quan
Stas suercbiag buck over more chan ft decades have
documented snus lees of poor perforranc. Howeren
tot people do noe helene that dere i a quality prbler
Many chink hae the cae eyered by thle doctor, ora
their communi is uses than the eae delivered i the

ution ar whole.
‘Whats needed ov nae dhe mation forward? "he Bs step
in improving cate wil be cutie aval af information

1m feat cate performance at les, Information stems
are needed hat can produce the neoensary mearures of care
soinely a pat ofthe proces. of delivering cae, Achisving
ai wil rogize a major overanl of cue autre ah nor
toation stems, witha focus on autorating the engy sat
tere ef key dara co suppom clini decisionmaking und
tw mreaute and report quality

(oformacion i esenil, bor ir ie enough, We need to
‘create teams of health piolewiemale—daeror, mare and

bale educatns—avha sok gel to give each indivi)
the care needed. Those eras zs have oo 20 ep them
quickly dent ch bese st of services foreach paren acl
hheahte eo expan the choices sles 3 chat patiens can
coe dhe eratment tha eight foe them

‘Communities need ro exaioe thc quay of cae nd
Alerersine bow ty might approach foal quali inkitnes,
Targe employers could pee eedeship to improve chronic
dlisege ea in ounpaon singe Healthcare specs could
callabormte wich cammntis aa improve preventive cae,

echaps mascimporcane,patienes mc take epensiiiy
for their care The shuld rk infrmedon om crusted
sourcer—sach sei pila, sth case agencies spcil-
ining in chee wmtiion or dae fe. the Annaican Dsberes
Ascociation), and ongenationsspcialinng in preventive care
(eg, the U.S. Preventive Servers Tk Force)—o kc what
bind if preven cate of tsrmnt they shouldbe civ,
then work sgh eee physicians 10 ere that ny gor re
fornia care, Paiens should wot asa thar tele pysi=
ian will ernember ll dat needs to he done. They can lp
thei physetars provide goad ear by being csv advocaer
fain

why Quofty Standards matter
Condition ‘What We Found tently Preventable Gotnplications or Deaths (anne
Disb “Arae od sugar nat scared tor 28% | 600 ind 28000 oy are

“94158 ad ct rene nds wehators
388 of eddy ers ravocne

©% notavetnnd

6,00 ats
37,0 deaths
1,008 sats
510 desthe i

Sours: Yoel SH, “The Nec for Peep In Evidence Based Medline,” Journal af the Accor Midha Anociston, Wt 292, 1999, p. SEH-2365,

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