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Quality Of Care

PROLOGUE

Quality Of Care

First, economist Joseph Newhouse raises the question of why we have a quality chasm, as characterized by the Institute of Medicine. Although it is clear that there are no shortcuts, Newhouse and others see hope in an increased use of information technology and financial incentives to disseminate information about best practices, enhance patient-physician communication, and facilitate medical record keeping. David Lansky, head of the Foundation for Accountability (FACCT), asserts that government should require public disclosure of performance information in connection with any health expenditure or benefit. He sees a public-private reporting partnership that will result in improved quality across the board.

But is simply reporting enough? Mark Chassin describes how New York State’s cardiac reporting system has reduced cardiac surgery deaths by 41 percent and has led to changes in the way cardiac surgery is performed in that state. This is excellent news. However, in New York the only hospitals that embraced the new procedures were those whose cardiac surgeries were in serious jeopardy. Even hospitals that were performing below average felt little incentive to overhaul their cardiac care programs to acquire an excellent rating. The market neither rewarded hospitals that improved mortality rates nor punished the underperformers.

What about the growing number of procedures that are conducted outside the hospital, beyond the reach of hospital accreditation and quality control? Elizabeth Lapetina and Elizabeth Armstrong discuss the respective approaches New York, Florida, and New Jersey have taken to reducing medical errors in outpatient settings. In a weighty essay, Robert Miller and Harold Luft update their review of studies of health maintenance organization (HMO) quality and cost containment and conclude that both HMOs and non-HMOs get mixed grades for their quality performance, but HMOs have reduced use of hospital and specialist resources and lowered some health care costs. They report a sharp increase in the number of studies of HMO performance in the five years since their last literature study, reflecting the research and funding communities’ increased focus on quality.

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