Tuesday, January 1, 2008

Want some standard oft-quoted nostrums backed up by widely used references? Here you go! But beware, that’s one of the problems.

Health care quality in the United States leaves much to be desired.

Kohn L. T., Corridgan J. M., Donaldson, J. M. (Eds.). To Err is Human. Building a Safter Health System. (Commmittee on quality of Health Care in America, Institute of Medicine, Washington DC: National Academy Press, 1999).

McGlynn, E. A., Asch, S., Adams, M. J., Keesey, J., Hicks, J., DeCristofaro, A Kerr, E. A. (2003). The quality of health care delivered to adults in the United States.” New Engl J Med 348, 2635-2645

Not only is quality less than it should be, it’s costing $1.7 trillion a year and has price increases four times the core inflation rate.

Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group and U.S. Department of Commerce, Bureau of Economic Analysis and Bureau of the Census. (n.d.).

National expenditure amounts. Retrieved November 19, 2005 from www.cms.hhs.gov/statistics/nhe/projections-2003/t2.asp

What can be done? How about creating a national electronic health record infrastructure….

Whitehouse. (2004). Transforming health care: The President’s health information technology plan. Retrieved November 19, 2005 from www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html

…or implementing consumer directed health plans….

Robinson, J. C., (2005). Consumer directed health insurance: The next generation. Health Affairs. Retrieved April 14, 2006 from http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.583v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=consumer+directed&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

…or recognizing physician effort with pay for performance…..

Rosenthal MB, Dudley RA: Pay for performance will the latest payment trend improve care? JAMA, 2007;297:740-744

….or mending the broken malpractice system….

Department of Health and Human Services. (25 July, 2002). Confronting the new health care crisis: Improving health care quality and lowering costs by fixing our medical liability system. Retrieved November 19 2005 from aspe.hhs.gov/daltcp/reports/litrefm.htm

…or implementing the medical home in every primary care site...

Bodenheimer, T., Wagner, E. H., Grumbach, K. (2002). Improving primary care for patients with chronic illness, JAMA 288, 1775-1779.

Bodenheimer, T., Wagner, E. H., Grumbach, K., (2002). Improving primary care for patients with chronic illness: The chronic care model, Part 2. JAMA 288, 1909-1914

.….or implementing disease management everywhere.

Sidorov, J., Schlosberg, C. (2005). “Disease management and the Medicare Modernization Act: ‘It’s the insurance, stupid.’” Disease Management, 8, 331-338.

Is it me or is there so much going on from so many different angles that no one seems to be coordinating these proposals? While each certainly has its merits, it seems to me no single proposal (guilty as charged) has the kind of “mass” it will take to truly transform healthcare, especially for the vulnerable elderly, minority populations or the chronically ill.

These nostrums may taste great but aren't really very filling when it comes to creating the “population-based" and "outcomes-driven care” for the types of patients who really need it.

Which begs the question: is caution the order of the day until we figure out how these initiatives will evolve and how to best integrate them?

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