Published in: The Boston Globe
Issue/Volume: 7/30/2008
Written by: Charles Kenney

7/30/2008 – SLOWLY BUT surely the long-held article of faith that the United States has the world’s finest healthcare is eroding in the face of mounting evidence. A fresh report from the prestigious Commonwealth Fund concludes that “despite spending more on healthcare than any other industrialized nation, the US overall continues to fall far short on key indicators of health outcomes and quality.”

The report found that even with lavish spending the United States ranked “last among 19 industrialized nations when it comes to premature deaths that could potentially have been prevented by timely access to effective healthcare.”

Given the Commonwealth Fund reputation for gold-standard reports, this work is taken seriously throughout the healthcare world. And while it is discouraging in many ways, there are elements within the study that are cause for optimism.

Dig deeper into the report – and look around at other indicators, as well – and it becomes clear that there are important trends in healthcare today which bode well for a future of improved quality. While incremental steps do not guarantee system transformation, these trends signal a dramatic new direction – perhaps one that will lead to a transformed healthcare system:

Institute for Healthcare Improvement campaigns. More than 3,700 hospitals throughout the country have enlisted in a coordinated attempt to protect millions of patients from preventable errors such as medication mistakes, surgical complications, pressure ulcers, and much more. Karen Davis, president of the Commonwealth Fund, wrote that her recent study shows that “performance on a key measure of patient safety – hospital standardized mortality ratios, which were targeted in the Institute for Healthcare Improvement’s [campaigns] – improved significantly, by 19 percent from 2000-2002 to 2004-2006.”

Measurement of clinical quality.
The trend toward measurement of clinical outcomes is irreversible. Regulatory agencies as well as businesses and consumer groups now insist on data measuring the quality of care in a wide variety of clinical areas. Individuals want to know which cancer surgeon has the best record, companies want to know which physician practice provides the best quality care for chronic diseases, and everybody wants to know which are the safest hospitals. (Transparency – opening up critical data for the world to see – goes hand-in-hand with measurement.)

Adoption of electronic health records. Increasingly, large physician practices and hospitals have upgraded from paper files to electronic health records. The best systems not only provide clinicians with all relevant information about a patient, they also offer clinical guidance that improves safety (averting medication errors, for example) and quality. A New York Times story in June indicated that a New England Journal of Medicine survey found that “82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors, and 85 percent said they improved the delivery of preventative care.”

Improved quality for some chronic diseases. Billions of dollars are spent each year on patients with chronic diseases who do not receive the recommended care designed to keep their conditions under control. Yet the Commonwealth Fund study reports a significant improvement in control of diabetes and high blood pressure – an extremely encouraging development.

Growing awareness that quality equals affordability.
This may be the most encouraging trend of all – the increasing awareness that the way to control costs is to provide higher quality care. The belief is that quality care for chronically ill patients, for example, keeps them healthier and out of the hospital, saving enormous amounts of money. Thus the trend toward creating contracts that call for providers to be paid not on the basis of procedures but on the basis of outcomes. Under this approach doctors who provided all the care needed to a population of diabetics, for example, would be improving their patients’ lives and rewarded financially.

Transforming the US healthcare system so it provides safe, high-quality care at a reasonable cost will not be easy. Not only is it not a sprint, it is a marathon – uphill and in the rain. But these and other indications hold out the promise that plugging away, we just might get there.