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US healthcare study: mediocre
Chron.com
By TODD ACKERMAN
Copyright 2006 Houston Chronicle
March 16, 2006

Black or white, rich or poor, American patients receive essentially the same quality of health care, according to a major new study — mediocre.

The study, published in today's issue of the New England Journal of Medicine, found that though there are some disparities, the world's most affluent health system fails to provide all patients with optimal care at least 40 percent of the time.

"Differences exist, but they pale in comparison to the chasm between where we are today and where we should be," said chief author Dr. Steven Asch of Rand Health and the Veterans Affairs Health Care System in Los Angeles. "No matter who you are, it's almost a flip of the coin as to whether you get the care that experts want for you."

Asch blamed the nation's "fragmented and chaotic" health-care system for making it difficult to deliver quality care and called for greater use of computers to track patient medical histories and provide electronic reminders of needed tests.

The study is the research team's third in a series on health-care quality in the United States. The previous ones found Americans receive proper care only 55 percent of the time, regardless of where they live. The new study breaks the findings down demographically.

The study's findings resonated with Houston health experts Wednesday.

"The United States spends more on health care than any other country yet lags behind on numerous health indicators," said George Masi, the Harris County Hospital District's chief operating officer. "We keep asking where we can do better. This gives an idea."

Vivian Ho, a professor of medicine at Baylor College of Medicine and professor of economics at Rice, said she was not surprised by the findings because "the health-care system has little incentive to provide the highest quality care and physicians must provide care in an increasingly complex, hard-to-keep-up-with medical environment."

Using phone interviews and reviews of patients' medical records, study authors examined whether 6,700 patients in 12 metropolitan areas, including Boston, Miami and Seattle (but not Houston) got the highest standard of treatment for 30 common conditions.

The health care was assessed using 439 quality indicators, some of them as basic as monitoring diabetics' blood sugar level, urging women 50 and older to get mammograms and prescribing aspirin and beta blockers to patients with heart conditions.

A well-functioning health-care system should provide recommended levels of care 80 to 90 percent of the time, study authors said. They didn't look at access to care, where previous studies have shown minorities fare worse than whites, instead focusing on the level of care patients receive once they get in the door.

Study authors emphasized that the technology to cope with the explosion in medical information is available, just underused.

They noted that after the Department of Veterans Affairs incorporated many of the improvements in electronic medical record-keeping, it was found to give patients proper recommended care about 66 percent of the time.

Masi noted that the Harris County Hospital District is in the first phase of rolling out such improvements.

He said a system by which a patient's X-rays and other images are available on computer screens instead of in files should be fully implemented by September.

"This study should be a challenge to all of us to fix our broken system," said Asch. "Providers can help build unified systems of care. Patients can advocate for better care. And payers can use their purchasing power to institute reforms in information technology."

todd.ackerman@chron.com

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