20041108 091 herken AN D SG 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, ‘bona cal BND Nach publican nd filo ef many march Sami rb san he RAND Hatha yada The RAND Compereten 2 mxpot enh cation prong abode atin ard eis ser el wae he helen aieg fo ple ond so torn he wall RAND pba dont mcr aod boii rec che ced gatas RAND ihe mr AND Ofer eh Nee » Wing «UGS = ei «take ets + cane + ihn