Quality of care - time to act

Article Abstract:

The development of new quality assessment tools has led to more objective measurements of the quality of care in the medical field. Increasingly, problems are being identified in the quality of care provided in the US. These problems can be placed into three general categories: overuse, underuse and misuse of medical care. Overuse is when risks of a health service outweigh benefits; underuse is when benefits outweigh risks, yet the service is not used; and misuse is when the service itself is improperly performed. In the December 25, 1991 issue of The Journal of the American Medical Association, two articles are presented that show how registry data can be used to study underuse. The first study by Hand and colleagues used breast cancer data from a cancer registry to examine if treatments proven effective in treating breast cancer were being properly utilized by hospitals. Their results showed that some of the treatments were not being fully utilized and observed certain characteristics of hospitals that were failing to properly utilize these treatments. In the second article by Lazovich and colleagues, breast cancer treatment data were again examined. The study examined if conservative surgery, which is now recommended for early-stage breast cancer, was generally being used, and if radiation therapy (which should accompany conservative surgery) was also being used. The results revealed that many women with early-stage breast cancer did not receive conservative surgery, despite the fact that only a small portion of the women were ineligible for conservative surgery. Radiation therapy was not given to 14 percent of the women who received conservative surgery. Both studies raised quality of care issues. Further research is needed to discover how and where quality of care was compromised for these patients. The research methodologies for these types of studies also need further refinement, but both reports show that objective assessments of quality of care are now available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Medical research, Breast cancer

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The missing ingredient in health reform: quality of care

Article Abstract:

The controversy over health care reform has often overlooked quality of care. Much of the debate has focused on access to and cost of health care, types of benefits and managed competition. Efforts to control costs may affect the quality of health care. Different measures can be taken to selectively decrease costs and the use of different health care services. These include developing a set of practice guidelines and developing different methods to assess quality of care. A research study examined the use of patient outcome from coronary artery bypass graft (CABG) surgery to assess quality of care. It found that CABG may be a reliable method for evaluating quality of care. One limitation of this method may be trying to accurately assess patient risk. Another limitation is that physicians and health plans may discriminate against patients with a high risk of a poor treatment outcome.

Management, Health care reform

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The Urgent Need to Improve Health Care Quality

Article Abstract:

The National Roundtable on Health Care Quality reports that the quality of health care varies considerably throughout the US and often has a significant impact on patients. The roundtable, convened by the Institute of Medicine, was composed of representatives of the private and public sector, practicing physicians and nurses, business leaders, consumer advocates, health journalists, and the heads of federal health programs. They analyzed the rapid changes in health care and how these changes would affect the quality of health and health care in the US.

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