Quality of Care in Medicine – Is It Improving?

By Dr Cary Presant MD

Everyone wants the best quality of medical care. Is our American health system quality of care high or low, and is it getting better or worse? We know that lack of insurance is associated with a reduction in amount of health care given and the quality of care that is received. But what is the quality of medical care for patients who are actively going to physicians?

In an article by Kevin O’Reilly in American Medical News (Volume 51, August 2008), the author reviewed data originally published in the July/August issue of Health Affairs. The results of over 150 Massachusetts physician groups were compared in the years 2001 and 2003 against quality care measurements. Interestingly, they also looked at their quality of care grades according to whether or not those physicians were paid extra fees for meeting quality care guidelines. The results were impressive.

Quality of care was generally high. In 2001 over 80% of female patients were getting breast cancer screenings. This continued to be high in 2003. Patients with diabetes were getting eye examinations (over 50% in 2001, and increased by 3% in 2003), testing for hemoglobin A1c (a measure of how well the blood sugar is being controlled) with 81% having such testing in 2001, and an increase of 4 to 6% in 2003, and screening for LDL cholesterol (a sign of higher risk of heart attack) with 80% of patients being screened in 2001 and an increase of 9% in 2003. Well child visits occurred in over 80% in 2001 with an increase of 5% in 2003.

This indicates that physicians are anxious to improve their quality of care, and that patients generally receive good quality care. When the authors looked to see if incentives to have increased guideline compliance resulted in increased quality of care, physician bonuses for performance-based improvements did not improve performance any better than groups who did not receive bonuses. This tells us that doctors just want to do a better job with their patients, and paying them a small amount extra does not seem to improve the care itself.

Also, it is important to recognize that even though quality of care was generally fairly high, 10% to 20% of patients did not receive adequate screening for disease (breast cancer), and in the evaluation of eye examinations for diabetic patients and monitoring of kidney function in diabetics, only 50% of patients received adequate screening and evaluation.

We need to recognize that in order to monitor doctor performance, it is necessary to have a system in place that actually checks each and every patient to determine if they are getting the high quality care that is necessary. This usually requires an Electronic Health Record, also called Electronic Medical Record, in order to make certain that each patient can be reviewed to make certain that each and every one of these screening tests, and that each and every appropriate treatment is given when it is needed. This sometimes requires payments for the process of measuring the process and the outcomes. Thus, there is continuing need for improvement in the quality of care.

What can you do now to make certain that your quality of care is high? First, ask your physicians if they routinely monitor their patients for compliance with quality guidelines? How do they do it and how often do they do it? Ask them if they have an Electronic Health Record, and if they do, how often do they use it to monitor patients and will you be monitored to know that your quality of care is high? Also, if your doctor does not have an Electronic Health Record, ask how they monitor the quality of care.

Even more importantly, get to know what screening tests are needed to maintain your health (through this column and through other health information resources such as brochures and books) and if you have a chronic illness, know exactly what is required for optimal treatment of that condition. We will have future columns that deal with where you can get information on certain quality issues, but you may always go to the National Institute of Health websites to obtain information about certain illnesses (but beware there is an awful lot of information and it is slow and is often very tedious to dig through it!)