Quality of U.S. health care is ailing, report finds


A report card that evaluated the quality of U.S. health care has concluded that American adults receive only about half of the treatments recommended for both acute and chronic conditions and half the recommended preventive care.

The Rand Corp. report, based on one of the largest studies of health care quality ever undertaken, says inadequate care translates into tens of thousands of deaths and unnecessary complications, posing "serious threats" to the public's health. The study was published in the journal Health Affairs.

"It's remarkable to me that we know a whole lot more about how to buy a toaster or a TV than about the performance of our health care system," author Dr. Elizabeth McGlynn, associate director of Rand, said in a telephone briefing yesterday.

The report found problems in all 12 metropolitan areas studied. "No community was best or worst. ... We found substantial deficits pretty much anywhere we looked," she said.

The study also found that quality was higher for certain medical conditions. Overall, cataracts received the best care, with 79 percent of the recommended standard, whereas alcohol dependence got only 11 percent and ulcers 30 percent.

The researchers focused on 30 conditions, both acute and chronic, including diabetes, asthma, hypertension and heart disease, as well as on preventive care. They interviewed 13,000 people and reviewed the medical records of 6,700.

In one of the most disturbing findings, the study reported that people with diabetes received only 45 percent of the standard care. Fewer than one-quarter had their average blood sugar levels measured regularly. Poor control of blood sugar can lead to kidney failure, blindness and limb amputation.

Among chronic conditions, high blood pressure was among those receiving the highest quality of care. Yet patients received less than 65 percent of the recommended standard.

Coronary artery disease scored 68 percent of recommended care, but only 45 percent of heart attack patients received beta blockers and 61 percent got aspirin, both of which can reduce risk of death, the report found.

Preventive care also fell short, particularly counseling for prevention of AIDS and substance abuse.

The study called on patients to "work with their physicians" and cautioned them not to assume their doctors will remember all that needs to be done.

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