Health Affairs, 22, no. 2 (2003): 128 doi: 10.1377/hlthaff.22.2.128 © 2003 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Research Challenge

PROLOGUE

Research To Address Quality Shortcomings

Joel Cohen and Nancy Krauss take a new look at identifying the priority conditions that require health care and the cost of and sources of payment for that care. One reason why a small proportion of the population accounts for a disproportionate share of medical expenditures is that most people with one of the top fifteen conditions also have other illnesses that require care, and therefore spending. Although chronic diseases were among the most expensive, acute conditions also generated high levels of spending, thus complicating efforts to find easy targets for spending reductions and improvement.

Sam Zuvekas and Gregg Taliaferro look at the quality issue from the front door, so to speak, examining who gets in to see the doctor and who doesn’t. They find that disparities in access and use persist among all racial/ethnic minority groups but are greatest among Hispanics, even when covered by private insurance. Next, Patrick Romano and colleagues introduce AHRQ’s new Patient Safety Indicators, red flags to the quality seeker, and apply them to administrative records of more than thirty-six million hospitalizations. Although they identify a distressing number of potential safety-related events or errors, the trend over the study period indicates that some errors are diminishing. However, others remain stubbornly prevalent, and yet others have increased. Finally, Anne Elixhauser, Claudia Steiner, and Irene Fraser produce administrative evidence to support decisions to seek out high-volume hospitals for complex surgical procedures. Their findings include baseline estimates of the number of hospitals that can be labeled high- or low-volume and the number of procedures performed in each. But they also look beyond the numbers to identify these hospitals’ staffing and other characteristics that might contribute to their surgical successes.

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