Jun 26 2003
A large research study reported on in the current issue of the New England Journal of Medicine has found that patients receive the correct diagnosis and treatment for a variety of different conditions only about 55% of the time.
The two-year, $6.5 million study looked at screening, diagnosis, treatment and followup of more than 30 conditions, identifying the various specific steps that should be taken for appropriate handling of the conditions. Proper steps were taken only 56% of the time, and frighteningly, as many as 11% of participants actually received care that was not recommended at all, or was potentially dangerous.Some of the oversights were particularly glaring. For example, only 24 percent of participants with diabetes received three or more glycosylated hemoglobin tests over a two-year period, and these tests are recommended annually or more often, to ensure better control of diabetes and prevention of serious complications. Only 45 percent of people who had a heart attack were given beta-blockers, which can reduce the risk of death by 13 percent during the first week of treatment and by 23 percent thereafter. Preventive care was also deficient. Only 64 percent of elderly participants received or were offered the pneumovax -- the pneumonia vaccine -- and 10,000 deaths each year are estimated to be preventable among this population if given this vaccine.
In an editorial that accompanies the research report, Dr. Earl Steinberg says that these results point up the need for four steps to be taken:
"First, quality of care should be measured and reported routinely at both the national and provider-specific (e.g., hospital and physician) levels...Second, we must make greater use of information technology...Third, in addition to capitalizing on the power of computers, we should draw on the power of patients to improve the quality of care they receive and their health outcomes...To engage consumers and empower them to take increased responsibility for their health and health care, we need to provide them with information about the care they should receive and consider receiving. To be effective, that information needs to be authoritative, easily accessible, easy to understand and to act on, timely, and personalized...The fourth and biggest problem that must be addressed is the fact that current financial incentives often discourage quality improvement."
Comment from Mary:
Given the known underdiagnosis and misdiagnosis of thyroid disease, and the recently revised lab standards for thyroid diagnosis that have yet to be understood by most doctors, it's likely that thyroid conditions fare even more poorly than better understood conditions such as heart disease and diabetes when it comes to quality of care.
What steps can you take to ensure better care? The main thing in your control is information, and being armed with information is the main way you can help ensure better care. Basically, you may need to know and understand your condition better than your own doctor, and take greater responsibility for ensuring that you are receiving the best possible care. This means staying educated, visiting sites like this regularly, subscribing to newsletters that report on the latest information regarding your thyroid disease, and reading patient guides to ensure you are an informed and empowered patient.
References:
Elizabeth A. McGlynn, Ph.D., et. al. "The Quality of Health Care Delivered to Adults in the United States." New England Journal of Medicine, Volume 348:2635-2645 June 26, 2003 Number 26.
Steinberg, Earl P., M.D., M.P.P. "Improving the Quality of Care — Can We Practice What We Preach?" New England Journal of Medicine. Volume 348:2681-2683 June 26, 2003 Number 26
