Need for Reform: Quality of Care

Life expectancies in developing countries

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Infant mortality in developing countries

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Patients and their families trust medical providers to deliver the highest quality of care. Yet medical care in many locations is mediocre at best and, at its worst, actually endangers patients. Following are significant issues related to delivery of quality care:

• Medical care not based on scientific evidence
• Inconsistent and uncoordinated care
• Disincentives created by financial reimbursement

Medical Care without Evidence-Based Medicine

Evidence-based medicine seeks to ground medical care on sound scientific knowledge to achieve consistent, safe, effective and efficient medical care. Numerous studies have shown medical care for any given medical condition varies from one medical center to the next or by geographic location, seemingly without reason. Attempts to establish best-practice guidelines for patient care have had little success. Among the multiple barriers to adopting evidence-based medicine:

Lack of Standards for Evidence
There is no consensus within the health care industry of what constitutes sound medical science or how to establish evidence-based medical practices.

Solo Practitioner Perspective
Medical professionals and the public, in many cases, view physicians as sole decision makers, capable of and expected to make decisions independently. Best-practice guidelines may be perceived as taking away that independent authority.

Lack of Quality Information
Physicians may be overwhelmed by new or conflicting research published in their field of practice. Providers lack processes or incentives for effectively sharing scientific knowledge. Finally, providers may not receive consistent, reliable best-practice guidelines to adopt into their medical practices.

The result is patients receive less effective medical care at higher personal and financial costs.

Inconsistent and Uncoordinated Care

Inconsistencies in care may appear when patients see multiple providers or specialists who do not share medical record information and provide treatments that may contradict each other.

Uncoordinated care can occur within hospitals or clinics when providers don't talk to each other. It also can occur when patients are transferred to another care center or home without the capabilities or understanding necessary to continue treatment needed for full recovery.

The Institute of Medicine has documented how inconsistent and uncoordinated medical care results in preventable medical errors that cause thousands of patient injuries and deaths each year.

Disincentives Created by Financial Reimbursement

Reimbursements for Medicare and Medicaid are often based on historical or political decisions, without consideration of quality of care. The problem is compounded when private insurers choose to mirror Medicare reimbursement policies. The result is financial reimbursement based on arbitrary factors such as geographic location of a medical provider, or historic trends, such as insurance coverage for acute medical care instead of less costly and more effective preventive care.

Sources

U.S. Agency for Healthcare Research and Quality
www.ahrq.gov

U.S. Department of Health & Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov

American Medical Association
www.ama-assn.org

The Kaiser Family Foundation
www.kff.org

University of Washington School of Public Health
sphcm.washington.edu