Improvements in Clinical Care: Study Reveals Disappointing Results

In the last decade, many laws and regulations have been introduced to focus on value-based care rather than a fee-for-service model. The results of a new study, however, indicate that many of the efforts to improve the quality of healthcare in America have had no consistent positive impact. The authors of the study concluded that ongoing deficits in clinical care continue to put the health of American citizens at serious risk.

What did the study show?

Researchers at Boston’s Brigham & Women’s Hospital and Harvard Medical School conducted a sweeping analysis of several aspects of outpatient care. They examined the quality of care Americans receive during office visits with physicians, nurse practitioners, and physician assistants. The study looked at 46 different measures and analyzed trends between 2002 and 2013.

The results are disappointing, to say the least. For instance, one in four Americans does not receive the necessary recommendations for cancer screening. In 10 years, this measure improved marginally overall, but critical areas, such as screening for cervical cancer and breast cancer, actually worsened.

Two measures – avoiding inappropriate medical treatment and avoiding inappropriate antibiotic use – worsened during the study period. Some other measures, such as diabetes care, avoiding inappropriate imaging, and recommendations for diagnostic and preventive testing, showed no improvement. According to study author and research fellow Dr. David Levine, a decade worth of efforts at improving the quality of clinical care delivered to Americans has shown no consistent positive results.

How does it impact the average American?

The study, published in the journal JAMA Internal Medicine in October 2016, identified several areas of concern such as wasteful expenditure and inappropriate use of medications. For example, approximately one in two Americans with a viral infection is prescribed antibiotics even though these medications are ineffective against viruses and despite strong evidence that antibiotic resistance is a rising global healthcare issue. As a result of this inappropriate use of antibiotics, the patient is not only exposed to possible side effects, but also unnecessary cost. The study also found that:

  • Roughly 25 percent of Americans do not receive appropriate recommendations for diagnostic and preventive screening tests
  • More than 30 percent of Americans do not receive appropriate recommendations for diabetes care
  • About 40 percent of older adults are subjected to inappropriate colon cancer screening
  • Approximately 60 percent of Americans do not receive treatments that can benefit lung and heart conditions

What went wrong? What should be done now?

The study authors are disappointed they did not see more significant improvements. Earlier groundbreaking studies had revealed that the American public was receiving only 50 percent of the ideal recommended care. Since then, local, regional, and national programs were implemented to ensure better and safer healthcare for Americans. However, the gap could not be bridged, says Elizabeth McGlynn, current director of the Kaiser Permanente Center for Effectiveness and Safety Research and lead author of a prior study. McGlynn and her colleagues argue that efforts were misdirected at measuring the quality of healthcare and not improving it.

Compounding the problem is an aging American population that is more ethnically diverse. Although more Americans are college-educated and fewer are smokers now, lifestyle factors have resulted in a substantial increase in the number of people battling three or more chronic diseases.

According to Levine, the fee-for-service model is largely to blame, driving healthcare providers to recommend treatments they will surely be reimbursed for. This type of healthcare system also sets the scene for medical errors. Electronic medical records can address the problem if they are used in patient care and not simply for billing. We will see bigger and better changes in healthcare once our system is smart enough to identify the patients who are not receiving the recommended care and the patients who are receiving inappropriate care, says Levine.

Image via National Cancer Institute

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