Ask the average person to name his top concerns about American health care and you will rarely hear quality of care mentioned. Consequently, many people may be surprised to learn that, according to a 1998 report by the respected Institute of Medicine, "Serious and widespread problems exist throughout American medicine." The report, entitled The Urgent Need to Improve Health Care Quality, goes on to say, among other things, that "Very large numbers of Americans are harmed as a direct result" of quality deficiencies, and that "Quality of care is the problem, not managed care."

That's why an article in the Journal of the American Medical Association in January, 2003 was such good news for seniors. The article documented measurable improvements during the past few years in the application of 22 "best practices" when caring for Medicare patients. These quality indicators were selected because they are strongly supported by scientific evidence and expert opinion. They included interventions for heart attack, heart failure, stroke, diabetes and pneumonia, as well as certain preventive measures.

Take type 2 diabetes, which affects nearly 20% of people over 65. Among the quality measures chosen by the researchers was whether an important monitoring test called an A1C had been performed at least once during the preceding year. In 1998-99, 70% of Medicare diabetics received the test, whereas in 2000-01 the number had climbed to 78%. As another example, 64% of heart attack patients received life-saving beta-blocker drugs in 1998-99 as compared with 69% in 2000-01. In fact, in all but two of the 22 measures studied, some improvement occurred. Does that mean health care quality should no longer be a concern to seniors?

Well, not really. Yes, the improvement is gratifying. But for simplicity and wider acceptance, the researchers deliberately chose minimal standards of care for their best practice measures. Regarding the A1C test, for example, authorities like the American Diabetes Association and the Joslin Clinic advise measuring the A1C test at least two to four times per year, not just once. And the report did not measure outcomes of care, such as the rate at which doctors achieved target levels of A1C in their patients. Had such standards been used, quality scores would have been much lower.

Virginia ranked eighteenth among the states in these recently published quality measures. But a consumer interested in knowing how his or her particular doctor or hospital performed would be out of luck, because the information isn't available. That's too bad, because widespread provider variation is common in our health system. Your own doctor or hospital might score perfectly or miserably on accepted measures of quality performance.

There are, however, many efforts underway to make comparative quality information available to consumers. Several states, including Utah, New York and Texas already publicize hospital quality scores. And, Medicare is asking hospitals nationwide to report their rates of compliance with certain evidence-based performance measures. The resulting comparative scores will be publicized for consumers on the website of the Center for Medicare and Medicaid Services, www.cms.hhs.gov. (Medicare already publishes similar information for nursing homes.) This is a good start, but seniors and other health care consumers will still have to wait a long time for detailed and usable quality information on all health care providers.

Meanwhile, how can concerned seniors be assured of receiving high quality care? Here are some suggestions:

• Speak up and ask questions. Choose physicians and other health care providers whom you feel comfortable talking to.
• Bring a friend or family member to appointments to help understand explanations and treatment options.
• Get the actual results of tests, x-rays or procedures. Don't just assume that "no news is good news."
• Be an active participant in decisions about your health care.
• Make sure that all your doctors know every medication you are taking, and that any drug allergies are recorded accurately.
• Learn as much as you can about your medical conditions and how they are best treated. Organizations like the American Heart Association, American Cancer Society, American Diabetes Association and others are excellent resources.
• Ask your physicians, hospital representatives and insurance plan about any quality performance statistics they make available to patients.

Where to get more information:
A wealth of information is available on health care quality. Here are two good places to start:
• The Agency for Healthcare Research and Quality, (301) 594-1364 www.ahcpr.gov (Click on Quality of Care in the Consumers and Patients section to see several online brochures for consumers)
• Healthfinder, an excellent online resource of health information from the federal government and its many partners. www.healthfinder.gov

February, 2003