Archive for Friday, March 2, 2001

Poor state of health care chronicled

March 2, 2001

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— Despite major advances in medical research and disease treatment, the American health-care system is failing to improve the care of patients, according to a major new report by the Institute of Medicine.

The report, released Thursday, said patients are getting stuck in a labyrinth in which doctors don't talk to one another, personal medical records are not easy to obtain, and insurance companies offer few incentives to provide quality, cost-effective care.

Perhaps most troubling, experts say, is that proven medical advances that can save lives are not being used in everyday practice.

"We are saying that the care is not satisfactory," said Dr. Donald Berwick, a member of the committee that wrote the report for the institute.

The Institute of Medicine is part of the National Academy of Sciences, a private organization chartered by Congress to advise the government on scientific matters.

"We are saying that major improvements are urgent, they're needed," said Berwick, who also is a professor at Harvard Medical School and president of the Institute for Healthcare Improvement in Boston.

Among the recommendations of the Committee on Quality of Health Care in America:

Ask Congress to establish a $1 billion fund to publicize examples of quality health care and transfer proven treatments into widespread use among doctors.

Urge all doctors and hospitals to make medical records available to patients without excessive costs or bureaucratic hassles.

Develop and promote detailed strategies to treat 15 chronic conditions, such as asthma, heart disease and diabetes.

Provide doctors and hospitals with financial incentives to improve patients' care.

The report follows another study by the Institute of Medicine, issued in November 1999, which attributed up to 98,000 deaths annually to medical errors.

The first report jolted lawmakers, health professionals and large employers. Several huge employers, including General Electric Co., IBM and Verizon Communications, created a coalition called the Leapfrog Group to reduce errors.

Leapfrog is asking all hospitals to install computer systems that allow physicians to enter prescriptions electronically. It wants physicians to refer patients with complex medical conditions to hospitals that have the best survival odds.

It wants to make sure that all intensive-care units are staffed by doctors trained in critical care.

Some medical experts say Thursday's report entitled "Crossing the Quality Chasm" accurately summarizes the problems within the health-care system.

At times, patients are asked to carry complicated messages between their doctors, rather than physicians communicating directly with each other. Sometimes, patients are forced to wait weeks before they can get an appointment to discuss potentially serious symptoms.

"We need to put the patients at the center of the health-care universe. While there may have been lip service to that in the past, we really need to design how we provide service around patients, around patients' needs," said Dr. Kenneth Kizer, president of the nonprofit National Quality Forum that deals with health care measurements.

Finally, biomedical advances discovered by the National Institutes of Health and other researchers are slow to be accepted by physicians. For example, only half of heart-attack patients are prescribed beta-blocker drugs, even though they are proven to dramatically reduce the risk of a second heart attack.

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