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Fam Pract Manag. 2004;11(6):27

National report card highlights opportunities for improvement

U.S. adults receive about half of the care recommended by the clinical literature, according to a new study conducted by the RAND Corporation. Researchers reviewed the medical records of about 6,700 individuals in 12 metropolitan areas and evaluated performance on 30 conditions against recommendations from national guidelines and the medical literature. (The quality indicators can be viewed online at

The study found that overall performance was similar across all of the communities studied, with a high of 59 percent in Seattle and a low of 51 percent in Little Rock, Ark., and Orange County, Calif. However, quality varied substantially across conditions:

  • Individuals with cataracts received the highest rate of recommended care at 79 percent.

  • Those with coronary artery disease received 68 percent of recommended care; however, only 45 percent of heart attack patients received beta blockers and 61 percent received aspirin.

  • Those with hypertension received less than 65 percent of recommended care.

  • Those with colorectal cancer received 54 percent of recommended care, but only 38 percent of adults were screened for colorectal cancer.

  • Those with diabetes received 45 percent of recommended care.

  • Those with pneumonia received 39 percent of recommended care.

  • Those with alcohol dependence received 11 percent of recommended care.

The RAND study provides some of the best estimates available about the quality of health care in the United States and reveals serious gaps between what clinicians know to be effective and what is actually provided. Among the most important factors needed to improve health care quality are routine measurement of health care performance and patients who take responsibility for their own care, say researchers.

PRACTICE PEARLS from here and there

Optimize your care team

Cohesive teams contribute to better clinical outcomes and higher rates of patient satisfaction. To build an effective care team within your practice, focus on five key elements:

  1. Establish clear goals with measurable outcomes (e.g., at least 80 percent of the practice’s patients with diabetes will have a hemoglobin A1c of less than 8 percent).

  2. Create detailed clinical and administrative systems, such as procedures for providing prescription refills or for scheduling patients.

  3. Outline a clear division of labor so that each team member knows which tasks he or she must perform.

  4. Ensure that all team members get the training they need to do their jobs well and are cross-trained to substitute for one another as needed.

  5. Communicate effectively through the use of protocols, face-to-face conversations and timely feedback rather than lengthy meetings.

– Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. 2004;291(10):1246-1251.

The doctor’s office vs. the ED

Increasing numbers of insured patients are turning to the emergency department when they would be better served in doctors’ offices or other clinic settings, according to a three-year study conducted by the Blue Cross and Blue Shield Foundation on Health Care and the Schneider Institute for Health Policy at Brandeis University. T he study looked at PPO claims for 2.2 million Americans and found that one in five ED visits were for low-acuity conditions, such as sore throat and minor rashes. In addition, more than half of hypertension patients who visited the ED had no physician visits in the prior year.

Specialists mask demand for primary care

A third of primary care services in Colorado are provided by non-primary-care specialists, according to research from the Robert Graham Center reported in the March/April issue of the Journal of the American Board of Family Practice. The survey of Colorado physicians found that, on average, specialists spent 12.5 hours per week providing primary care. “The significant amount of primary care services provided by non-primary-care specialists should be taken into consideration when researchers and policy-makers are looking at what doctors are needed where. Are there enough primary care physicians available to meet the demand? Our research suggests not,” said lead author George E. Fryer Jr., PhD.

Discounted drug resource

The Pharmaceutical Research and Manufacturers of America has created a new, interactive Web site ( aimed at simplifying the process for obtaining free or discounted prescription drugs for needy patients. The site offers access to 40 patient-assistance programs providing more than 400 different medications. Patients or physicians simply answer a series of brief questions via the Web site and are presented with a list of patient-assistant programs that may be suitable. They can then apply online using a standardized form.

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Copyright © 2004 by the American Academy of Family Physicians.

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