Study says the push for quick treatment detracts from care
By Ronald Kotulak
Tribune science repoter
May 10, 2005
Doctors are failing to provide Americans with the best care that modern medicine
has to offer, according to a national survey of physicians that puts the blame
on a revolving-door system of medicine in which doctors are rewarded for
sacrificing quality to see patients as fast as they can.
The findings are in line with the results of other studies suggesting that as
advances in medicine increase dramatically and drugs, surgical procedures and
other treatments become more effective, doctors are falling behind in their
ability to transfer the benefits to patients.
The study, carried out by the Commonwealth Fund, found that a majority of
doctors are not involved in improving the quality of their practices, are
reluctant to share information about the quality of care they provide with the
public, and have seen instances where quality of care was compromised.
"It is shocking that doctors don't know what the quality of their care is
compared to their peers, are very reluctant to make such information available
to their patients and the public, and are not continually engaged in major
efforts to improve care," said the Commonwealth Fund's executive vice
president, Dr. Stephen Shoenbaum, co-author of the report.
The study, reported in Tuesday's issue of the journal Health Affairs, called on
physicians to support measures to improve quality, but other experts said more
action is needed, such as changing the payment system so doctors are rewarded
financially for providing better care.
Quality of care is measured through a broad range of factors, from blood tests,
access to patient records and drug prescriptions to keeping up with the newest
treatments and how often patients should be seen and followed up with.
Several pilot projects have been launched in the U.S. to test the feasibility of
paying doctors more for providing more comprehensive care to patients. In
Britain the government will begin paying primary care doctors up to 37 percent
more per year for providing top-notch care.
The Commonwealth Fund study surveyed more than 1,800 physicians nationwide and
found that 58 percent said their income was based on their productivity and half
said they would lose money on providing quality care. Physicians in solo
practice or small groups were found to be more likely to neglect quality-of-care
measures than those in large groups or academic medical centers.
"The variability of quality in the U.S. and the overall low level of
quality compared to what it could be, and the fact that not all that much is
being done to improve it, really is a national scandal that people are just not
aware of," said Dr. Lawrence Casalino, assistant professor of health
studies at the University of Chicago.
Casalino found similar results in a study of 1,040 medical groups that he and
his colleagues reported in the Journal of the American Medical Association in
January 2003.
They looked at 16 quality-of-care measures for asthma, diabetes, congestive
heart failure and depression and found that on average the medical groups
provided less than a third of the recommended procedures.
The problem has less to do with unwillingness on the part of doctors to improve
care than with a system that pays doctors for seeing more patients, Casalino
said. "We have a fabulous medical technology and, for the most part, very
dedicated and well-educated doctors. The problem is with the system."
The Illinois State Medical Society and the American Medical Association are
concerned about problems with quality care and have worked with doctors to
improve their performance, said Dr. Michael O'Toole, a cardiologist with Midwest
Heart Specialists in DuPage County who works with both organizations on
performance standards.
"We believe in the need for good quality care and some accountability in
that care," he said. "The patients we care for have a right to know
what's good quality care, and at some level the people paying the bills should
know what's good quality care."
The Commonwealth Fund study found that three-fourths of the physicians did not
use electronic medical records to keep track of their patients, two-thirds were
not involved in efforts to redesign systems to improve care, and two-thirds did
not have any feedback about the quality of their own clinical performance.
One out of 10 doctors said they often or sometimes saw patients receiving the
wrong drug or wrong dose, one out of three said they often or sometimes felt a
patient's care was compromised, and one out of three said tests or procedures
had to be repeated because of errors.
"If the medical system were a bank, you wouldn't deposit your money here,
because there would be an error every one in two to one in three times you made
a transaction," said Dr. Stephen Persell, who studies quality medicine
issues at Northwestern University's Feinberg School of Medicine.
Of the physicians surveyed, 69 percent said the public should not have access to
information on physician performance. But 55 percent said patients should have
that information on their physicians, and 71 percent said physician performance
data should be available to the leaders where they work.
"Physicians want to perform high-quality care, but they have huge financial
and cultural barriers to changing their practice," Persell said.
"Without a major external motivation, they're not going to be able to make
big improvements in health-care quality."
