http://www.usatoday.com/news/health/2003-06-25-medical-quality_x.htm

On average, doctors provide appropriate health care only about half
the time, a landmark study of adults in 12 U.S. metropolitan areas
suggests.

Such deficiencies "pose serious threats to the health of the
American public" that lead to tens of thousands of preventable
deaths each year, researchers report in today's New England Journal
of Medicine.

The authors say their work is the largest and most comprehensive
examination of the quality of health care in the USA. Though the
study stopped short of linking inappropriate care to the poor health
or death of individual patients, it shows that Americans cannot take
for granted that they're getting good care, says lead author
Elizabeth McGlynn, associate director of RAND Health.

The study involved 7,528 adults who participated in a telephone
interview about their health history and provided access to their
medical records.

Researchers used the medical records to assess care for 30 common
conditions as well as preventive care. They based their evaluation
on 439 indicators of quality gleaned from established national
guidelines and medical literature. For example, if patients had high
blood pressure, researchers checked whether their doctors had
changed their medication to better control blood pressure. For
preventive care, researchers examined factors such as cancer
screening and flu shots for the elderly.

Overall, patients' medical charts showed that doctors provided 55%
of appropriate care. On average, that proportion varied little among
the chronic, acute or preventive care categories. McGlynn
acknowledges that it's possible that doctors didn't write everything
down in patients' charts. But that in itself represents poor-quality
care, she says. "How can they proactively follow up on something if
they don't have a note on the chart?"

The key to improving health care quality would be to provide
performance data on all U.S. doctors, McGlynn says. Such a step
would require "a major overhaul of our current health information
systems," she and her colleagues write.

Carolyn Clancy, director of the Agency for Health Quality and
Research, says Health and Human Services Secretary Tommy Thompson is
eager to switch to a more efficient paperless health care system.

In an accompanying editorial, Earl Steinberg writes that
it's "ludicrous" to expect physicians to keep up with hundreds of
practice guidelines without a computerized system. "I reliably
receive reminders when my dog needs a vaccination," writes
Steinberg, of Johns Hopkins University. "Physicians and patients
should also receive computer-driven reminders."

Karen Ignagni, president of the American Association of Health
Plans, commended the study in a statement: "We couldn't agree more
that consumers in America's health care system face a dangerous
disconnect between what the best medical science recommends and the
treatment they often receive."

Note - the following was in the paper but not posted on the web page!

Hit-and-miss health care
The study on medical care found that:

Patients with high blood pressure received 65% of recommended care.
Poor blood pressure control contributes to more than 68,000
preventable deaths annually, researchers say.

Only 45% of heart attack patients received beta-blockers, which have
been proven to reduce the risk of dying by 23%.

A third of patients had been screened for colorectal cancer. Routine
screening and follow-up care could prevent about 9,600 deaths each
year.