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Patients suffer thousands of preventable complications and deaths each year due to quality deficits in the care that they receive, including in cities such as Boston, which has world-renown hospitals, according to a new study.

Patient Safety Monitor Alert, May 12, 2004

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Patients suffer thousands of preventable complications and deaths each year due to quality deficits in the care that they receive, including in cities such as Boston, which has world-renown hospitals, according to a new study.

The "Community Quality Index" released by the Santa Monica, CA-based non-profit research organization May 4, examined how effectively care is delivered in 12 metropolitan areas throughout the U.S. It reveals that clinicians in some communities still fail to provide care that they "know" is medically effective, according to researcher Elizabeth McGlynn, PhD, associate director of RAND Health, and colleagues.

These quality deficits persist despite initiatives by both the federal government and private health care delivery systems to improve care.

To define and measure quality, the research team developed a set of quality indicators, known as the RAND Quality Assessment Tools system. RAND staff selected 30 clinical areas representing the leading causes of death and disability as well as the major reasons that people seek care. They developed specific standards or quality indicators within each clinical area, based on a review of national guidelines and the medical literature. Panels of experts evaluated the proposed quality indicators.

The researchers then devised a quality "score" for each patient. The score was based on the number of times that the patient received the care recommended across all of the conditions that the patient had in a two-year period, divided by the number of times that the patient was determined to need specific healthcare interventions. The team then aggregated the individual scores to obtain quality scores for various dimensions of performance.

Among their findings:

>> Patients receive the recommended care for their conditions only 46% of the time, but receive potentially harmful treatment only 11% of the time.

>> No single community consistently had the highest or lowest performance for all of the chronic conditions, although the rankings of each community changed depending on the type of care that the study examined.

>> Patients receive the same basic level of performance for chronic, acute, and preventive care throughout the country whether they received the care in Seattle, WA, or Little Rock, AK.

>> Quality varied substantially across conditions, however. For example, people with cataracts received about 79% of recommended care while those with alcohol dependence received recommended care only about 11% of the time.

>> All communities did a better job of preventing chronic disease through screening tests (e.g., measuring blood pressure) and immunizations compared with other types of preventive care-for example, prevention of sexually transmitted diseases and HIV and counseling for substance abuse.

>> Care for such chronic conditions as heart problems, depression, and diabetes varied depending on the condition and the community in which the care was rendered.

RAND calls the report "the largest and most comprehensive examination ever conducted of healthcare quality in the United States." The report is published in the journal Health Affairs.

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