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Appendix A: Report of the Technical Panel on the State of Quality to the Quality of ealth Care in America Committee
Pages 225-308

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From page 225...
... As a result of overuse, underuse, and misuse of health care services, our society pays a substantial price. The opportunity costs of poor quality include years of life lost or spent with major or minor impairments, pain and suffering, disability costs, and lost productivity.
From page 226...
... Examples include the following: · performance of major surgery (e.g., hysterectomy, coronary artery bypass graft) without appropriate reasons; · provision of antibiotics for the common cold and other viral upper respi ratory tract infections for which they are ineffective; .
From page 227...
... Even with comprehensive insurance coverage, however, much of the population fails to receive recommended preventive services, and many patients do not receive the full range of clinically indicated services for acute and chronic conditions. Examples include the following: · Cardiac care In a study of 3,737 Medicare patients with a diagnosis of heart attack who were eligible for treatment with beta blockers, only 21 percent were found to have received beta blockers within 90 days of discharge.
From page 228...
... NEED FOR FURTHER WORK The panel' s work represents a modest effort to review the state of health care quality. Specifically, the literature review was commissioned for this study limited in the following ways: · It focused only on publications in leading peer-reviewed journals.
From page 229...
... 1995, Aspirin in the Treatment of Acute Myocardial Infarction in Elderly Medicare Beneficiaries: Patterns of Use and Outcomes. Circulation 92:2841-7.
From page 230...
... The team could be collocated or comprise a dispersed network of individual providers practicing and communicating with each other as a team. The certification requirements could be used as a measure of quality by consumers and as a tool for quality improvement by teams seeking to obtain such certification.
From page 231...
... In September 1996, President Clinton established the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, which has released its final report on how to define, measure, and promote quality of health care (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 19981. Much of the interest in quality of care has developed in response to the dramatic transformation of the health care system in recent years.
From page 232...
... The best process measures are those for which there is research evidence that better processes lead to better outcomes. For example, controlling blood pressure reduces mortality from stroke and heart disease; performing routine mammography identifies breast cancer at an earlier stage so that a cure is more likely; prescribing inhaled corticosteroids reduces the likelihood and severity of asthma flare-ups.
From page 233...
... This assessment can be done by creating a list of quality indicators that describe a process of care that should occur for a particular type of patient or clinical circumstance and by evaluating whether patients' care is consistent with the indicators. Quality indicators are based on standards of care, which are either found in the research literature and in statements of professional medical organizations or determined by an expert panel.
From page 234...
... We report baseline rather than follow-up data because the former are more likely to be representative of the quality of care provided around the country. Quality measurement conducted after a specific intervention shows the potential for interventions to improve quality, but until such interventions are commonplace, these post-intervention results are unlikely to represent what is taking place in most parts of the country.
From page 235...
... One study found that only about one in five eligible patients with a heart attack received beta blockers within 90 days of hospital discharge and also that those who received the treatment were much less likely to die than those who did not (Soumerai et al., 1997~. Another study showed that poorer quality of care for children with asthma was associated with more hospitalizations (Homer et al., 1996~.
From page 236...
... is not provided. Overuse indicates the reverse a health care service is provided when the potential risks outweigh the potential benefits (i.e., inappropriate care)
From page 237...
... It is recommended that patients with insulin-dependent diabetes mellitus have an annual dilated eye examination (the clinician uses drops to enlarge the pupil to see behind it more easily) starting five years after diagnosis and that patients with non-insulin-dependent diabetes mellitus have the exam annually starting at the time of diagnosis.
From page 238...
... In a study of patients in New York State who underwent coronary artery bypass graft surgery, 1.6 percent had surgery for inappropriate reasons (Leape et al., 1996~. Nonetheless, the majority of studies described in the tables show much room for improving quality.
From page 239...
... As mentioned above, one study with particularly striking results found that only 21 percent of eligible patients with a heart attack received beta blockers within 90 days of hospital discharge (Soumerai et al., 1997~. Although patients with cardiovascular dis
From page 240...
... Average adherence rates for select indicators made publicly available by NCQA fell primarily in the 60 to 70 percent range, with the extremes at 38 percent for diabetic eye exams (past year) and 84 percent for initiation of prenatal care in the first trimester (Thompson et al., 1998~.
From page 241...
... In New York State (NYS) , risk-adjusted mortality for coronary artery bypass graft (CABG)
From page 242...
... REFERENCES Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
From page 243...
... 1998. Resource Use and Quality of Care for Medicare Patients with Acute Myocardial Infarction in Maryland and the District of Columbia: Analysis of Data from the Cooperative Cardiovascular Project.
From page 244...
... 1995. Quality of Care for Medicare Patients with Acute Myocardial Infarction: A Four-State Pilot Study from the Cooperative Cardiovascular Project.
From page 245...
... 1995. The Decline in Coronary Artery Bypass Graft Surgery Mortality in New York State: The Role of Surgeon Volume.
From page 246...
... 1994. Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Surgery between Canada and New York State.
From page 247...
... 1996. A Regional Intervention to Improve the Hospital Mortality Associated With Coronary Artery Bypass Graft Surgery.
From page 248...
... 1997. Adverse Outcomes of Underuse of Beta-Blockers in Elderly Survivors of Acute Myocardial Infarction.
From page 249...
... 1988. The Appropriateness of Performing Coronary Artery Bypass Surgery.
From page 250...
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From page 308...
... to be included. For this search, articles with any of the Medical Subject Headings (MeSH)


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