The gap between the best possible care and the healthcare that is actually delivered remains quite large despite an increased focus on evidence-based practice guidelines, according to a report in the June 27 issue of the Archives of Internal Medicine.
Using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, researchers at Stanford University School of Medicine found that the percentage of visits during which patients received appropriate care improved significantly from 1992 to 2002 for only six of 23 quality indicators. These were: treatment of depression (83.4% from 46.7%); statin use for hyperlipidemia (36.9% from 9.6%); inhaled corticosteroid use for adults with asthma (42.2% from 25.4%); inhaled corticosteroid use for children with asthma (35.8% from 10.9%); avoiding routine urinalysis (72.8% from 63.4%); and avoiding inappropriate medications in the elderly (94.6% from 91.8%).
Increases were actually shown in 11 other categories, but the researchers classified these gains as "modest" or not statistically significant.
There is a commonly held belief that it takes 17 years for medical practices to go from research to widespread practice, said the report's co-author, Jun Ma, and the study's findings lend evidence to this theory.
"Our data offer support for that notion because, as we observed over a 10-year period, we find no or little progress in the majority of the quality indicators," Ma said.
The report also found that race and ethnicity appear to make little difference in the quality of care patients receive. Ma said this finding was "interesting" but should not be overemphasized. She did, however, have a theory on why this may be so. "We should look at access to healthcare as a root cause of disparities -- not unequal treatment after someone gets into the healthcare system," Ma said.
The researchers found only two statistically meaningful differences that were linked to race. Compared to non-Hispanic whites, non-Hispanic blacks with chronic heart failure were more likely to receive ACE inhibitors (45% vs. 32%). And non-Hispanic whites were less likely to receive unnecessary antibiotics for uncomplicated upper respiratory tract infection than blacks (74% vs. 53%).
The report suggested that the place where care was delivered sometimes made a difference, as preventive counseling was more likely to be offered in a private physician office than in a hospital outpatient department. And hospital outpatient departments were more likely to perform unnecessary electrocardiography (96% vs. 93.7%) and urinalysis (81.4% vs. 73.7%), the report said.
The Institute of Medicine report Crossing the Quality Chasm, which is credited with spurring quality-improvement efforts in healthcare, was released in 2001 and so there was little time for it to affect the quality measures the Stanford researchers tracked in 2002. But Ma believes the results of the study wouldn't have changed much even if they compared 1995 to 2005.
"Even though I don't have the latest data to support my thoughts, I don't think anything significant has changed in the last three years," she said.
View the study abstract.