England Journal of Medicine Reports That Patients
Get Proper Health Care Only About 50% of the Time
According to a new study published in the New England
Journal of Medicine, patients receive the appropriate
recommended care from health care providers only 54.9
percent of the time.
The study utilized telephone surveys in 12 metropolitan
areas to identify willing participants who would provide
a health history and listing of their health care
providers. Those who agreed signed written consent
forms so that their medical records could be reviewed.
The initial sample included 20,028 adults. Medical
records were then reviewed for acute and chronic conditions
that represented the leading causes of death and illness.
Physicians then reviewed national guidelines and medical
literature and applied that to the review of each
The average age of the patients in the survey was
44.7 years. Women had higher rates of visits and whites
had higher visit rates than blacks. In terms of adherence
to quality indicators according to condition, coronary
artery disease recommended care was received only
68% of the time. Moreover, only 45% of persons presenting
with a myocardial infarction (heart attack), received
beta-blockers, which reduce the risk of death by 13%
during the first week of treatment and 23 % over the
Cerebrovascular disease patients received recommended
care only 59.1% of the time and colon cancer patients
received the recommended care only 53.9% of the time.
Among elderly patients, only 64% had received or been
offered a pneumonia vaccine when nearly 10,000 preventable
deaths from pneumonia annually occur.
The study notes that only 24% of participants in
the study with diabetes received three or more blood
sugar tests over a two year period. This routine monitoring
is essential to the assessment of the treatment and
identification of complications of this disease at
an early stage.
Persons with hypertension (high blood pressure) received
the recommended care only 64.7% of the time. Poor
blood pressure control contributes to more than 68,000
preventable deaths annually.
The authors of the study say their report is the
largest and most comprehensive examination of the
quality of health care in the United States. The lead
author, Elizabeth McGlynn says that the study demonstrates
that Americans cannot take for granted that they are
getting good care.
The report's conclusion is that "These deficits,
which pose serious threats to the health of the American
public, persist despite initiatives by both the federal
government and private health care delivery systems
to improve care." The authors suggest that a
key component of the potential solution will be to
make information on performance available at all levels.
"Making such information available will require
a major overhaul of our current health information
systems, with a focus on automating the entry and
retrieval of key data for clinical decision making
and for the measurement and reporting of quality."
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