Physicians fail to follow recommended care guidelines for almost half of their cases, which could pose "serious threats to the health of the American public," says a comprehensive study published yesterday in the New England Journal of Medicine.
Doctors carry out recommended practices 55% of the time, a level of performance that proved similar for preventive care, acute care and care for chronic conditions, says the study, conducted by Elizabeth McGlynn of Rand Health, a consulting company based in Santa Monica, Calif.
Quality was found to vary substantially by medical condition, ranging from 79% of recommended care for senile cataracts to about 11% for alcohol dependence.
Any future progress will require a "major overhaul of our current health information systems," the researchers write, with a focus on automating data entry and retrieval "for clinical decision making and for the measurement and reporting of quality."
The study, funded by the Robert Wood Johnson Foundation, examined treatment of 30 medical conditions and preventive care for which there are 439 recommended actions, guidelines or other indicators for quality care. The data was culled from a review of 6,712 patients in 12 cities in conjunction with the Community Tracking Study of the not-for-profit Center For Studying Health System Change, based in Washington, D.C.
Most other quality studies have focused on a single condition, fewer indicators, a single geographic area or a population defined by type of insurance coverage.
"For the nation to make serious progress on quality, we must have routinely available, at every level in the healthcare system, the type of information produced for this study," says David Lawrence, M.D., in a statement. Lawrence is retired chairman and CEO of the Kaiser Foundation Health Plan and Hospitals.
Other condition-specific findings of the study include:
- Pneumonia patients received 39% of recommended care. Fewer than two-thirds of the elderly received pneumonia vaccinations.
- People with diabetes received 45% of the care they need. Less than a quarter of diabetics had their blood-sugar levels measured regularly, for example.
- Patients with colorectal cancer received 54% of recommended care, and only 38% of adults were screened for colorectal cancer.