More About Quality Health Care

More About Quality Health Care

In every community, both good and bad care is being provided in hospitals and doctor's offices. There are too many mistakes, too much miscommunication and too much inequity in our health care system.

Quality care is care that works – based on the best medical research about what has made you ill and what will make you better.

You can't take good quality care for granted.

Most Americans believe that the health care they receive is the best that medicine and science can provide. While we have some of the brightest, best trained, and most committed health care professionals in the world, we know that patients aren't getting the best care in the world. We spend more in total and more per capita on health care than any other country in the world. But the U.S. ranks 10 th in life expectancy among major industrialized nations and 27 th in infant mortality.[i]

A 2004 study of 12 U.S. communities found that just over half (54.9 percent) of people were receiving the care they needed. As many as 91,000 Americans die each year because they don't receive the right evidence-based care for such chronic conditions as high blood pressure, diabetes and heart disease. [ii]

Fortunately, quality can be measured and it can be improved. Quality health care happens when you take an active role in your own care.

But how do you know whether the care you get is good quality care?

Quality health care is about getting

• The right care - care that works—you should be given the type of care that medical research has shown to work best for your condition.
• At the right time - care when you need it - your care should be timely. You should be given as much care as you need, but no unnecessary care.
• For the right reason - your care should be given by health professionals who are skilled and knowledgeable. They should be respectful, communicate clearly and involve you in decisions about your care.

Poor-quality care comes in three forms: overuse, underuse and misuse.

We give people care they do not need, we fail to give people care that we know works, and we make mistakes that hurt or kill people.

UNDERUSE: We do not give people the care they should get. We neglect to give them medically necessary care or to follow proven health care practices—such as giving beta-blocking drugs to people who have heart attacks.

MISUSE: We make errors throughout the health care system. Some errors are human, but systems within hospitals, doctors' offices, and elsewhere can be designed to greatly reduce the risk of error.

• Between 44,000 and 98,000 people die annually from preventable errors—more than from motor-vehicle accidents, breast cancer or AIDS. [iii]
• Health care-associated infections in hospitals account for an estimated 1.7 million infections and 99,000 associated deaths each year. [iv]
• Health care providers make more than 1.5 million medication errors each year, causing an estimated 7,000 deaths annually. [v]
• Medication errors for hospitalized patients cost roughly $2 billion annually. [vi]
• We tolerate margins of error in health care that are orders of magnitude higher than in other sectors of the economy. Most processes within health care experience 6,000 to 300,000 defects per million opportunities. This compares to error rates of 230 or fewer per million opportunities for world-class manufacturers and fewer than five errors in every million financial-service transactions. [vii]
• OVERUSE. Americans get a lot of health care that we don't know doesn't help them. We often treat people without medical justification—for example, giving antibiotics for simple infections—or fail to follow equally effective options that cost less or cause fewer side effects. No one likes the idea of being denied health care that is necessary and life-saving. But by the same token, we should not want health care that costs far too much without generating any results.
• Antibiotics are prescribed inappropriately for children's ear infections 13 million times a year—802 times out of every 1,000 doctor visits—despite the finding that more than 80 percent of infections get better within three days without antibiotics. [viii]
• From 1993 to 2003, spending for lumbar fusion (a type of back surgery) rose 500 percent—from $75 million to $482 million—despite a lack of evidence supporting the effectiveness of back surgeries. [ix]
• As many as 78 Medicare patients per 1,000 are hospitalized for conditions like poorly controlled diabetes or worsening heart failure that could have been managed on an outpatient basis. [x]
• Some regions of the country use vastly more resources to treat patients with similar illnesses without achieving better outcomes. A whopping 30 percent of health care spending—nearly $700 billion a year—is for services that may not improve people's health. [xi]

What can YOU do to help make sure you are getting good quality care?

Once you understand that quality of health care does vary, it's clear you can't take good quality for granted. There is a lot you can do to improve the quality of care you and your loved ones receive. Quality health care happens when you take an active role in your own care. You will need to be actively involved in finding and using information that tells about health care quality.

• For many people getting peace of mind begins with their relationship with their doctor. The key is finding the right doctor—one who values relationships based on openness and trust, and who provides high-quality care. For more information on How to Find the Right Doctor click here.
• For people in good health, good care means care that balances prevention and treating illnesses.
• For people with chronic conditions, good care means understanding what treatment is proven to work for what condition, and making sure that you're getting that level of care.
• For people with loved ones who get sick or hurt, good care means knowing where to go to get the best care, without a lot of delays, hassle or misinformation.
• For people who give care, quality care means that you are able to do your job and help people and systems are designed to help you do that.
• For all people who receive health care, we all need to learn and act on the differences between good and bad care, just like we choose where we live based on how good the schools are and how safe our neighborhoods are.

[i] OECD Health Data 2008. France: Organization for Economic Co-operation and Development and IRDES (Institute for research and information in health economics), 2008. (No authors given.)

[ii] The Essential Guide to Health Care Quality. Washington: National Committee for Quality Assurance, 2007. (No authors given.)

[iii] Kohn LT, Corrigan JM, Donaldson, MS (eds). To Err Is Human: Building a Safer Health Care System. Washington: National Academies Press, 2000.

[iv] Klevens RM, Edwards JR, Richards CL, Jr., et al. "Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002." Public Health Reports, 122: 160-166, 2002

[v] Aspden P, Wolcott J, Bootman JL, et al. (eds). Preventing Medication Errors: Quality Chasm Series. Washington: National Academies Press, 2007.

[vi] Kohn LT, Corrigan JM, Donaldson, MS (eds). To Err Is Human: Building a Safer Health Care System. Washington: National Academies Press, 2000.

[vii] Kohn LT, Corrigan JM, Donaldson, MS (eds). To Err Is Human: Building a Safer Health Care System. Washington: National Academies Press, 2000.

[viii] Subcommittee on Management of Acute Otitis Media. "Diagnosis and Management of Acute Otitis Media." Pediatrics, 113(5): 1451-1465, 2004.

[ix] Weinstein JN, Lurie JD, Olson PR, et al. "United States trends and regional variations in lumbar spine surgery: 1992-2003." Spine, 31(23): 2707-2714, 2006.

[x] Fisher ES, Goodman DC, Chandra A. Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project. Princeton, NJ: Robert Wood Johnson Foundation, 2008.

[xi] Orszag P. Increasing the Value of Federal Spending on Health Care. Washington: Congressional Budget Office, 2008.

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