One of the most perplexing questions in healthcare is whether quality of care is a national movement, exists only in silos of excellence or merely amounts to good public relations. Despite a multitude of quality organizations, demonstration projects and calls to arms, the hard evidence simply doesnt back up the claim that things have changed in any systematic way.
This is not to say they wont, and it is not to dismiss the health systems that have adopted cultures that strive toward cost-effective, safe and high-quality careeven when the payment system fails to adequately reward them for it. Nor is it to minimize the good work of organizations such as the Leapfrog Group and the Institute for Healthcare Improvement. They are the engines pointing the way down the right track; its just that not nearly enough cars are in line behind them.
As our cover story this week shows, two new reports on healthcare quality, access and cost at the state level offer yet another depressing view of the numbers. One of them, by the Agency for Healthcare Research and Quality, attempts to be a little bit upbeat, but cant quite pull it off. It examined 129 different measures of quality across the panoply of care and found that while some states do some things better than others, no state is good at everything.